March 2017
Community Needs
Assessment
PREPARED FOR
THRIVE Mat-Su—United Way of Mat-Su
PREPARED BY
THRIVE Mat-Su PFS
Community Needs Assessment
FINAL DRAFT
Prepared for:
THRIVE Mat-Su
Prepared by:
McDowell Group Anchorage Office
1400 W. Benson Blvd., Suite 510
Anchorage, Alaska 99503
McDowell Group Juneau Office
9360 Glacier Highway, Suite 201
Juneau, Alaska 99801
Website: www.mcdowellgroup.net
March 2017
Table of Contents
Acknowledgments......................................................................................................................... 1
Executive Summary ....................................................................................................................... 2
Overview ......................................................................................................................................................................... 2
Prescription Drug Misuse ......................................................................................................................................... 2
Heroin .............................................................................................................................................................................. 6
Prevention Resources................................................................................................................................................. 9
Recommendations and Next Steps ...................................................................................................................... 9
Introduction and Background.................................................................................................... 12
THRIVE Mat-Su ........................................................................................................................................................... 12
Partnerships for Success Grant ............................................................................................................................. 13
Strategic Prevention Framework.......................................................................................................................... 13
Methodology ............................................................................................................................... 15
Methods ........................................................................................................................................................................ 15
Community Factors ................................................................................................................................................... 17
Methods for Prevention Matrix ............................................................................................................................ 17
Community Needs Assessment Structure ........................................................................................................ 18
Technical Notes ........................................................................................................................... 19
Acronyms ...................................................................................................................................................................... 19
Definitions .................................................................................................................................................................... 19
Data Notes ................................................................................................................................................................... 20
Community Landscape ............................................................................................................... 23
Prescription Opioids
Literature Review ........................................................................................................................ 28
Use Patterns ................................................................................................................................................................. 28
Risk and Protective Factors .................................................................................................................................... 31
Social Availability ....................................................................................................................................................... 32
Retail Availability ........................................................................................................................................................ 33
Prescription Drug Monitoring ............................................................................................................................... 34
Perception of Risk for Harm .................................................................................................................................. 35
Community Readiness Results ................................................................................................... 36
Community Readiness Score................................................................................................................................. 36
Community Readiness Responses Themes...................................................................................................... 36
Consumption ............................................................................................................................... 38
Lifetime Use of Prescription Drugs ..................................................................................................................... 38
Past 30 Days Use of Prescription Drugs ............................................................................................................ 44
Consequences .............................................................................................................................. 50
Poisoning ...................................................................................................................................................................... 50
ED Discharges ............................................................................................................................................................. 50
Dependence or Abuse ............................................................................................................................................. 51
Deaths ............................................................................................................................................................................ 52
Arrests ............................................................................................................................................................................ 52
Risk and Protective Factors ........................................................................................................ 53
Risk of Harm from Prescription Drug use as Moderate or Greater ........................................................ 53
Parents View Prescription Drug Use as Wrong or Very Wrong ............................................................... 55
Friends Consider It Wrong or Very Wrong ...................................................................................................... 58
Retail Availability of Prescription Opioids ........................................................................................................ 59
Drug Take Back........................................................................................................................................................... 59
Community Messaging about Prescription Opioids .................................................................................... 60
Provider Discussions with Young Adults about Prescribed Opioids ...................................................... 60
Unused Prescription Drugs Disposal .................................................................................................................. 61
Community Problem ................................................................................................................................................ 62
Risk of Harm for Trying Prescription Opioids ................................................................................................. 62
Risk of Harm for Regularly Misusing Prescription Opioids........................................................................ 63
Community Factors ..................................................................................................................... 64
Social Availability of Prescription Opioids........................................................................................................ 64
Retail Availability of Prescription Opioids ........................................................................................................ 65
Perceived Risk of Prescription Opioids .............................................................................................................. 66
Heroin
Literature Review ........................................................................................................................ 69
Community Readiness Results ................................................................................................... 72
Community Readiness Score................................................................................................................................. 72
Community Readiness Responses Themes...................................................................................................... 72
Consumption ............................................................................................................................... 75
Lifetime Heroin Use .................................................................................................................................................. 75
Consequences .............................................................................................................................. 80
Emergency Department Discharges ................................................................................................................... 80
Deaths ............................................................................................................................................................................ 81
Arrests ............................................................................................................................................................................ 81
Risk & Protective Factors ........................................................................................................... 82
Community Problem ................................................................................................................................................ 82
Risk of Harm ................................................................................................................................................................ 82
Heroin Availability ..................................................................................................................................................... 83
Community Factors ..................................................................................................................... 84
Perceived Risk of Heroin Use ................................................................................................................................ 84
Social Availability of Heroin ................................................................................................................................... 85
Prevention Resources and Next Steps
Prevention Resources Assessment ............................................................................................ 87
Recommendations and Next Steps ........................................................................................... 89
Community-Level Recommendations and Next Steps................................................................................ 89
Long-Term Community Recommendations .................................................................................................... 90
Long-Term Statewide Recommendations........................................................................................................ 91
Appendices
Appendix A: Data Tables ............................................................................................................ 93
Middle School ............................................................................................................................................................. 93
High School ................................................................................................................................................................. 95
Appendix B: Young Adult Substance Use Survey .................................................................... 99
Appendix C: Data Source Descriptions ................................................................................... 102
American Community Survey (ACS) ................................................................................................................ 102
Youth Risk Behavior Survey (YRBS) .................................................................................................................. 102
National Survey on Drug Use and Health (NSDUH).................................................................................. 104
Young Adult Substance Use Survey (YASUS) ............................................................................................... 105
National Poisoning Data System (NPDS)....................................................................................................... 105
Health Facilities Data Reporting Program (HFDR) ..................................................................................... 106
CDC WONDER ......................................................................................................................................................... 107
Appendix D: References ........................................................................................................... 109
Appendix E: National Survey of Drug Use and Health Data ................................................. 111
Appendix F: Community Readiness Respondent Characteristics ......................................... 112
List of Tables
Table 1. Prescription Drug Misuse Consumption Patterns, Mat-Su, 2015............................................................................. 4
Table 2. Prescription Drug Misuse and Heroin Use Risk and Protective Factors, Mat-Su, 2015 ................................... 5
Table 3. Prescription Drug Misuse Consequences, Mat-Su, 2009-2013 and 2015............................................................. 6
Table 4. Prescription Drug Misuse and Heroin Use Consumption Patterns, Mat-Su, 2015 ............................................ 8
Table 5. Prescription Drug Misuse and Heroin Use Consequences, Mat-Su, 2009-2013, 2015 .................................... 8
Table 6. Readiness Level and Readiness Stage ...............................................................................................................................16
Table 7. Readiness Level and Readiness Stage ...............................................................................................................................16
Table 8. Acronym List and Definitions................................................................................................................................................19
Table 9. Symbols for Statistical Comparison ...................................................................................................................................22
Table 10. Mat-Su Borough and Alaska Population, by Age Group, 2015 ............................................................................23
Table 11. Mat-Su Borough and Alaska Population, by Gender, 2015 ...................................................................................23
Table 12. Mat-Su Borough and Alaska Population, by Race Alone, 2015 ...........................................................................24
Table 13. Mat-Su Borough Population 12 to 25 Years, by Race Alone, 2015 ....................................................................24
Table 14. Mat-Su Borough and Alaska Selected Economic Indicators, 2011-2015 Five-Year Estimates .................26
Table 15. Mat-Su Borough School District and Alaska Selected Education Indicators, School Year 2015-2016 .26
Table 16. Risk Factors for Non-Medical Use of Prescription Opioid by Domain ..............................................................31
Table 17. Protective Factors for Non-Medical Use of Prescription Opioids by Domain ................................................32
Table 18. Prescription Drug Community Readiness Scoring Results .....................................................................................36
Table 19. Lifetime Use of Prescription Drugs, Middle School Students, 2015 ...................................................................39
Table 20. Lifetime Use of Prescription Drugs, Traditional High School Students, 2015.................................................42
Table 21. Lifetime Use of Prescription Drugs, Alternative High School Students, 2015 ................................................44
Table 22. Current Use of Prescription Drugs, Middle School Students, 2015 ....................................................................45
Table 23. Current Prescription Drug Use, Traditional Students, 2015 ...................................................................................47
Table 24. Current Use of Prescription Drugs, Alternative Students, 2015 ...........................................................................49
Table 25. Number and Rate of Opiate Poisonings, Mat-Su, 2012-2015 ..............................................................................50
Table 26. Number of Opioid-Related ED Discharges and Rate per 1,000 ED Discharges, ............................................51
Table 27. Number of Prescription Opioid-Related Emergency Department Discharges ..............................................51
Table 28. Mat-Su Pain Reliever Non-Medical Dependence. 2002-2011 ..............................................................................51
Table 29. Number of Prescription Opioid Deaths, Other Opioid Deaths, ............................................................................52
Table 30. Number of Arrests for Misconduct Involving ..............................................................................................................52
Table 31. Risk of Harm Moderate or Greater, Middle School Students, Mat-Su, 2015 ..................................................53
Table 32. Risk of Harm from Prescription Drug Use as Moderate or Greater, Traditional High School Students,
Mat-Su, 2015 ................................................................................................................................................................................................54
Table 33. Risk of Harm from Prescription Drug Use as Moderate or Greater, Alternative High School Students,
Mat-Su, 2015 ................................................................................................................................................................................................55
Table 34. Parents View Prescription Drug Use as Wrong or Very Wrong, Middle School Students, Mat-Su, 2015
...........................................................................................................................................................................................................................56
Table 35. Parents View Prescription Drug Use as Wrong or Very Wrong, Traditional High School Students, 2015
...........................................................................................................................................................................................................................57
Table 36. Parents View Prescription Drug Use as Wrong or Very Wrong, Alternative High School Students, MatSu, 2015 ..........................................................................................................................................................................................................58
Table 37. Friends Consider Wrong or Very Wrong, Middle School Students, Mat-Su, 2015 .......................................59
Table 38. Number and Percent of Young Adults Who Have Ever Been Prescribed Opioids,.......................................59
Table 39. Reported Pounds Collected During Drug Take Back Events, Various Mat-Su Communities ..................60
Table 40. Risk of Harm When People Try Misusing Prescription Opioids, Mat-Su and Alaska, 2015 ......................62
Table 41. Risk of Harm When People Regularly Misuse Prescription Opioids, Mat-Su and Alaska, 2015 ..............63
Table 42. Heroin Community Readiness Scoring Results ...........................................................................................................72
Table 43. Lifetime Heroin Use, Traditional High School Students, Mat-Su, 2015 .............................................................77
Table 44. Lifetime Heroin Use, Alternative High School Students, Mat-Su, 2015 ............................................................79
Table 45. Number of Heroin-Related ED Discharges and Rate per 1,000 ED Discharges, ............................................80
Table 46. Number of Heroin-Related Discharges and Percent of Population, ..................................................................80
Table 47. Number of Prescription Opioid Deaths, Other Opioid Deaths, ............................................................................81
Table 48. Number of Arrests for Misconduct Involving ..............................................................................................................81
Table 49. Risk of Harm When People Try Heroin, Mat-Su and Alaska, 2015......................................................................82
Table 50. Risk of Harm When People Regularly Use Heroin, Mat-Su and Alaska, 2015 ................................................83
Table 51. Mat-Su Heroin Availability. 2002-2011 ..........................................................................................................................83
Table 52. Prevention Resources ............................................................................................................................................................88
Table 53. Prescription Drug Indicators, Middle School Students, Mat-Su and Alaska2015 .........................................93
Table 54. Prescription Drug Indicators, Middle School Students, Mat-Su and Alaska, 2011 and 2015 ...................94
Table 55. Prescription Drug Indicators, All, Traditional and Alternative High School Students, Mat-Su 2011 and
2015, and Alaska and U.S., 2011 and 2015.......................................................................................................................................95
Table 56. Community Messaging About Prescription Opioids Seen .....................................................................................99
Table 57. Discussions of Appropriate Opioid Use Between Providers/Pharmacists and Young Adults Prescribed
Opioids Within Past Three Years, Mat-Su and Alaska, 2015 .....................................................................................................99
Table 58. Disposal of Leftover, Unused Prescription Opioids Among Young Adults ................................................... 100
Table 59. Perception of Prescription Opioid Misuse as a Community Problem, Mat-Su and Alaska, 2015........ 100
Table 60. Perception of Heroin as a Community Problem, Mat-Su and Alaska, 2015 ................................................. 101
Table 61. Available Years and Demographic Breakouts of YRBS Data, by School Type and Region ..................... 102
Table 62. October 1 Enrollment Totals for MSBSD Middle Schools.................................................................................... 103
Table 63. October 1 Enrollment Totals for MSBSD High Schools Sampled by YRBS, .................................................. 103
Table 64. Mat-Su and Alaska Population, Ages 12-25, 2012-2015 ..................................................................................... 105
Table 65. Mat-Su Borough 2015 Population Estimates, by Age and Gender .................................................................. 106
Table 66. ICD-9 and ICD-10 Codes for Prescription Opioid and Heroin-Related.......................................................... 107
Table 67. Mat-Su Borough Population Estimates, All Ages, 2009-2013 ............................................................................ 108
Table 68. Prescription Drug Indicators, Mat-Su, Alaska, and the U.S. ................................................................................ 111
Table 69. Opioid Community Readiness Respondents by Sociodemographic Variables ......................................... 112
Table 70. Heroin Community Readiness Respondents by Sociodemographic Variables ........................................... 113
List of Figures
Figure 1. Components of THRIVE Mat-Su Community Needs Assessment ........................................................................12
Figure 2. Steps of Strategic Prevention Framework......................................................................................................................13
Figure 3. Mat-Su Borough Population, by Race Alone, Percent, 2015 ..................................................................................24
Figure 4. Mat-Su Borough Five-Year Interval Population Trends, Count, 1990-2015 .....................................................25
Figure 5. Mat-Su Borough Five-Year Interval Population Projections, Count, 2015-2045 ............................................25
Figure 6. Lifetime Use of Prescription Drugs, Middle School Students, Mat-Su, Percent, 2011, 2013, and 2015
...........................................................................................................................................................................................................................38
Figure 7. Lifetime Use of Prescription Drugs, Middle School Students, ...............................................................................38
Figure 8. Lifetime Use of Prescription Drugs, All High School Students, .............................................................................39
Figure 9. Lifetime Use of Prescription Drugs, All High School Students, .............................................................................40
Figure 10. Lifetime Use of Prescription Drugs, Traditional High School Students, ..........................................................40
Figure 11. Lifetime Use of Prescription Drugs, Traditional High School Students, ..........................................................41
Figure 12. Lifetime Use of Prescription Drugs, Alternative High School Students, ..........................................................42
Figure 13. Lifetime Use of Prescription Drugs, Alternative High School Students, ..........................................................43
Figure 14. Current Use of Prescription Drugs, All High School Students, ............................................................................45
Figure 15. Current Use of Prescription Drugs, All High School Students, ............................................................................46
Figure 16. Current Use of Prescription Drugs, Traditional High School Students, ...........................................................46
Figure 17. Current Use of Prescription Drugs, Traditional High School Students, ...........................................................46
Figure 18. Current Use of Prescription Drugs, Alternative High School Students, ...........................................................48
Figure 19. Current Use of Prescription Drugs, Alternative High School Students, ...........................................................48
Figure 20. Rate of Opiate Poisonings Per 10,000 Persons Age 12-25, Mat-Su and Alaska, Percent, 2012-2015
...........................................................................................................................................................................................................................50
Figure 21. Community Messaging About Prescription Opioids Seen by Young Adults, ...............................................60
Figure 22. Discussions of Appropriate Opioid Use Between Providers/Pharmacists and Young Adults Prescribed
Opioids Within Past Three Years, Mat-Su and Alaska, Percent, 2015....................................................................................61
Figure 23. Disposal of Leftover, Unused Prescription Opioids Among Young Adults ....................................................61
Figure 24. Perception of Prescription Opioid Misuse as a Community Problem, Mat-Su and Alaska, Percent, 2015
...........................................................................................................................................................................................................................62
Figure 25. Community Factors that Impact the Social Availability of Prescription Opioids .........................................65
Figure 26. Community Factors that Impact the Retail Availability of Prescription Opioids ..........................................66
Figure 27. Community Factors that Impact the Perceived Risk of PO...................................................................................67
Figure 28. Lifetime Heroin Use, All High School Students, Mat-Su, Percent, 2011, 2013, and 2015 ........................75
Figure 29. Lifetime Heroin Use, All High School Students, Mat-Su and Alaska, Percent, 2011, 2013, and 2015 .75
Figure 30. Lifetime Heroin Use, Traditional High School Students, Mat-Su, Percent, 2011, 2013, and 2015.......76
Figure 31. Lifetime Heroin Use, Traditional High School Students, .......................................................................................76
Figure 32. Lifetime Heroin Use, Alternative High School Students, Mat-Su, Percent, 2011, 2013, and 2015 ......77
Figure 33. Lifetime Heroin Use, Alternative High School Students, .......................................................................................78
Figure 34. Perception of Heroin as a Community Problem, Mat-Su and Alaska, 2015 ..................................................82
Figure 35. Community Factors that Impact the Perceived Risk of Heroin Use ..................................................................85
Figure 36. Community Factors that Impact the Social Availability of Heroin .....................................................................86
Acknowledgments
THRIVE Mat-Su would like to thank all the Coalition members and community members that assisted in the
2017 Community Needs Assessment focused on preventing heroin and opioid misuse. Your invaluable
contributions, information and insights will help our community become stronger, healthier, and more resilient.
Members of the THRIVE Mat-Su Coalition include
•
ACRF
•
Mat-Su Reentry Coalition
•
Adult & Teen Challenge
•
Mat-Su Borough School District
•
Akeela
•
Mat-Su Health Foundation
•
Alaska Family Services
•
Mat-Su Youth Court
•
Alaska Family Services/Breathe Free
•
MY House
•
Alaska State Troopers
•
National Guard
•
American Cancer Society, Inc.
•
Onward & Upward
•
American Lung Association of AK
•
Palmer Police Department
•
Big Brothers Big Sisters
•
Palmer Rotary
•
Boys & Girls Club of Alaska
•
Real Life Church
•
Colony High School
•
U.S. Senator Lisa Murkowski
•
Co-Occurring Disorders Institute
•
U.S. Senator Dan Sullivan
•
Country Legends 100.9
•
Set Free Alaska
•
Division of Juvenile Justice
•
State of Alaska
•
Fiend2Clean
•
Southcentral Foundation
•
Greater Palmer Chamber of Commerce
•
Sunrise Rotary
•
Knik Tribal
•
Sunshine Community Health Center
•
Life Changers
•
United Way of Mat Su
•
Mat-Su Coalition for the Prevention of Suicide
•
Wasilla High School
•
Mat-Su Health Services
•
Wasilla Homeless Committee
•
Mat-Su Public Health
•
Wasilla Police Department
We would like to extend our thanks to the following organizations who assisted in providing data:
University of Alaska Anchorage Center for Behavioral Health Research & Services
Mat-Su Regional Medical Center Emergency Department
Matanuska-Susitna Borough School District
State of Alaska Division of Health and Social Services
Division of Public Health, Youth Risk Behavior Survey Program
Division of Behavioral Health, Prevention and Early Intervention
Division of Behavioral Health, Policy & Planning Section
Mat-Su THRIVE PFS Community Needs Assessment
McDowell Group, Inc.  Page 1
Executive Summary
Overview
Introduction
This Community Needs Assessment presents a snapshot of prescription opioid misuse and heroin use in the
Mat-Su Valley. It reviews national literature, compiles and reports available community level data on the issue,
summarizes results of a survey on the community’s readiness to act on the issues, describes available prevention
resources, and prioritizes key factors impacting issues.
Partnerships for Success – Prevention Efforts
THRIVE Mat-Su, the region’s substance use prevention coalition, received the Partnerships for Success grant
from the State of Alaska Division of Behavioral Health. It is a four-year grant focused on prevention of
prescription drug misuse and heroin use. The grant funds focus on youth and adults ages 12 to 25.
Community Landscape
Of the total Mat-Su population, 18.6 percent were age 12-25 years (18,662 residents). Of those residents:
•
52.8 percent were male and 47.2 percent female.
•
78.4 percent were White, 8.4 percent Alaska Native and/or American Indian, 1.5 percent Black or Africa
American, 1.7 percent Asian, 0.4 percent Native Hawaiian or other Pacific Islander, and 9.6 percent two
or more races.
Prescription Drug Misuse
Literature Review
Research literature documents a parallel relationship between increased legitimate use of opioids and a
significant rise in non-medical use of these drugs in the U.S. Non-medical use of prescription opioids can lead
to a prescription opioid disorder, progressive use to heroin, and possible death. While it is not clear if gender is
a factor in who uses, it does appear to be a factor in how prescription opioids are accessed via different channels
and for different purposes, and the manifestation of that use. White individuals have higher rates of non-medical
use of prescription opioids than individuals of other races. Non-medical use of prescription opioids morbidity
and mortality has increased around the country, but death and injury from use is higher in states with large rural
populations, including Alaska. Increased retail availability of the drugs drives social availability in rural areas.
Development of prescription opioid abuse and dependence is more likely when initiation of non-medical use
of prescription opioids begins prior to the age of 18.
Community level risk and protective factors include peer drug use, peer attitudes towards drug use, rural areas,
availability among peers, and norms against non-medical use of prescription opioids among youth.
Mat-Su THRIVE PFS Community Needs Assessment
McDowell Group, Inc.  Page 2
Community Readiness
Scoring Results
•
Most community members were unaware of community efforts for prescription opioid misuse and there
is a lack of knowledge about existing efforts.
•
Leadership is aware of the issue, but a hesitation exists to do anything without community support for
action.
•
In terms of community climate, the negative media concerns people. They do not know where to start
on the problem or what they can do to help.
•
Generally, the community reported an awareness that some resources exist, but they do not know where
they are located or how to access these resources to address the issue.
Themes
•
Access issues emerged as a key issue. Community members cited easy access to home medicine
cabinets with extra prescription opioids. People are acquiring drugs through hospice, family, friends,
schools, work places, and other social outlets. There are not enough permanent drug disposal
opportunities in existence to dispose of the medicine beyond its medical need.
•
Misconceptions about risk on multiple levels. Individuals do not understand how easy it is to get
addicted. There is a lack of understanding about the relationship between prescription drug use and
heroin use among the general population. Additionally, there are misconceptions about who is
impacted by prescription drug misuse in the community, and a lack of understanding it impacts all
populations even seniors.
•
Community strengths include peer-to-peer support programs, treatment centers, community and
physician education efforts, media coverage, and efforts from THRIVE Mat-Su and the Mat-Su Opioid
Task Force.
•
Education on the issue has support, though it could be strengthened. The community, patients, and
doctors need additional education.
•
Community awareness exists; however, the awareness is largely from the reporting of crimes and other
negative attention rather than a reflection of the whole issue.
Data Summary
A key for displaying statistical differences is presented in Table 9. Symbols for Statistical Comparison.
CONSUMPTION PATTERNS
Overall, Mat-Su consumption patterns do not statistically differ with consumption seen elsewhere in Alaska and
in the U.S. No statistical difference is shown by a gray block in Table 1 below.
In 2015, approximately 226 middle school students in the Mat-Su reported misusing prescription drugs during
their lifetime, of which an estimated 129 have used in the past 30 days.
•
In 2015, approximately 765 high school students in the Mat-Su reported misusing prescription drugs
during their lifetime, with about 363 reporting having used in the past 30 days.
Mat-Su THRIVE PFS Community Needs Assessment
McDowell Group, Inc.  Page 3
o
Misuse among alternative schools is higher than misuse by traditional students during their
lifetime (39.4 percent vs. 15.0 percent respectively, about 2.6 times higher), and during the past
30 days (20.1 percent vs. 6.9 percent, or 2.9 times higher).
Table 1. Prescription Drug Misuse Consumption Patterns, Mat-Su, 2015
Indicator and Group Population
Percent
95%
Confidence
Interval
Estimated
Number of
Students
Statistical
Difference
between
Mat-Su &
Alaska
Comparison
Between
Mat-Su &
U.S.
Prescription Drug Misuse
Lifetime Misuse of Prescription Drugs
Middle School Students
10.5
7.8 – 14.0
226

NA
All High School Students
17.7
14.9 – 21.0
765
NA
NA
Traditional High School Students
15.0
11.8 – 18.9
582
Alternative High School Students
39.4
34.7 – 44.3
174




Past 30 Days Use of Prescription Drugs Without a Prescription
Middle School Students
6.0
3.7 – 9.4
129

NA
All High School Students
8.4
6.9 – 10.2
363
NA
NA
Traditional High School Students
6.9
5.2 – 9.0
268
NA
Alternative High School Students
20.1
15.4 – 25.7
89


NA
NA: Not Available
Source: YRBS.
RISK & PROTECTIVE FACTORS
Perception of Risk and Harm
Among middle school students:
•
Three-quarters consider misuse of prescriptions drugs as a moderate or great risk.
•
Nearly nine out of ten reported their parents considers prescription drug misuse as wrong or very
wrong.
Among all high school students:
•
About eight out of ten consider prescription drug misuse as a moderate or great risk.
•
Nine out of ten reported their parents consider prescription drug misuse as wrong or very wrong.
Alternative high school students reported lower levels of “risk perception” for both indicators presented, i.e.,
they did not consider prescription drug misuse as risky as traditional high school students. No statistical
difference is shown by a gray block in Table 2 below.
Mat-Su THRIVE PFS Community Needs Assessment
McDowell Group, Inc.  Page 4
Table 2. Prescription Drug Misuse and Heroin Use Risk and Protective Factors, Mat-Su, 2015
Indicator and Group Population
Prescription Drug Misuse
Percent
95%
Confidence
Interval
Estimated
Number
of Persons
Statistical
Difference
between
Mat-Su &
Alaska
Comparison
Between
Mat-Su &
U.S.
Perception of Harm from Prescription Drug Misuse as Moderate or Greater
NA
Middle School Students
75.4
69.4 – 80.5
1,626

All High School Students
82.9
79.7 – 85.6
3,586
NA
NA


NA
Traditional High School Students
83.9
80.3 – 87.0
3,259
Alternative High School Students
73.8
68.3 – 78.6
326
NA
Student Perception that Parents Consider Prescription Drug Misuse as Wrong or Very Wrong
Middle School Students
87.6
83.9 – 90.6
1,890

NA
All High School Students
91.8
90.0 – 93.3
3,971
NA
NA
Traditional High School Students
92.6
90.7 – 94.1
3,597
NA
Alternative High School Students
86.2
80.7 – 90.4
381


NA
NA: Not Available
Source: YRBS.
Retail Availability, Messaging, Provider Discussions
When Mat-Su residents ages 18-25 were surveyed:
•
Half (50.1 percent) had been prescribed opioids in the past three years and more than half (56.2 percent)
still had the unused prescription opioids.
•
40.6 percent had not seen any messages about prescription opioids.
•
About a quarter (24.5 percent) viewed prescriptions drug misuse as a very large problem in the
community.
•
38.5 percent viewed misusing prescription drugs as a great risk of harm for trying once or twice and
only 61.5 percent viewed regular misuse of prescription opioids once or twice a week as a great risk.
•
In discussions of appropriate opioid use with providers:
o
53.7 percent were informed of side problems from use
o
41.5 percent discussed using pills as prescribed only
o
Nearly a third (31.7 percent) advised to not share with others
o
Nearly a third (29.3 percent) discussed expected benefits
o
About one in five discussed safe and secure storage of pills (22.0 percent) and alternatives to
prescription opioids (19.5 percent).
Consequences
•
In 2015, Mat-Su residents had 159 visits to an emergency room for prescription drug misuse related
reasons. During this time, there were 13 prescription opioid poisonings in the emergency room.
•
Between 2009 and 2013, there was an annual average of 11.2 deaths per year due to prescription
opioids, and an annual average of 12.6 deaths per year due to all opioids.
Mat-Su THRIVE PFS Community Needs Assessment
McDowell Group, Inc.  Page 5
Table 3. Prescription Drug Misuse Consequences, Mat-Su, 2009-2013 and 2015
Number
(2015)
% of Total Mat-Su Resident
Discharges
159
0.5
13
Total Deaths
(2009-2013)
56
8.7
Average Annual Deaths Per Year
63
12.6
Indicator
Prescription Drug Misuse (2015)
Prescription Opioid-Related ER Discharges
Prescription Opioid ER Poisonings
Indicator
Prescription Opioid Deaths (2009-2013)
All Opioid Deaths (2009-2013)
11.2
Source: HFDR and CDC WONDER.
Community Factors
•
Social Availability: Key issues associated with social availability of prescription opioids included:
o
Lack of safe and positive support and supervision
o
Focus on understanding pain management: “pain” is the 5th vital sign (along with the four vital signs:
pulse, respiration, blood pressure and temperature).
•
•
o
Geographical factors small rural communities sharing “resources”
o
Lack of disposal knowledge and disposal sites
o
Family and friends who are addicted or use prescription opioids in the home increase access
Retail Availability: Key issues associated with retail availability:
o
Overprescribing
o
Medication assisted treatment (MAT) is providing drugs rather than treatment
o
Pain is the 5th vital sign: pain management vs pain free
o
Lack of education regarding addiction by people and providers
o
Lack of prescription drug monitoring
o
Lack of prescription drug disposal sites
o
Online purchasing (fentanyl)
Perceived Risk of Prescription Opioids: Key issues around perceived risk of harm:
o
“Specific” risk education by primary providers and pharmacies
o
Community and family norms
o
Lack of broad education through schools and media
Heroin
Literature Review
Research indicates the significant increase in prevalence of heroin use and abuse over the past decade has been
driven primarily by the increase in heroin use among young adults ages 18 to 25. Early initiation of non-medical
use of prescription opioids is a known risk factor for heroin use. Male young adults have reported significantly
higher rates of lifetime, past-year, and past-month heroin use than have females of the same age. Non-Hispanic,
white young adults have statistically higher prevalence rates of lifetime, past year, and past month heroin use
compared to other races. Unlike prescription opioid misuse, there is no significant variation in heroin use by
young adults living in large, small, or non-urban areas. In general, young adults perceive heroin, crack, and
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methamphetamine as the most risky and harmful drugs. Research describes that availability of heroin, unlike
availability of prescription opioids, is a result of international trafficking of heroin.
Community Readiness
Scoring Results
•
Community knowledge of the issues comes from the media, personal connections to the drug, and
needles found around the community.
•
Leadership seem to support change, but they do not see it as a top priority.
•
The community climate needs some work. Community members see needles and media around heroin,
but community climate engagement only occurs when they have a personal connection.
•
There is little to no knowledge about the problem in the community or about local services or resources
available. Knowledge only occurs when it becomes a personal issue; however, the problem and available
resources/services should be community information.
•
In terms of resources, people think they exist, but are unaware of where or the process of how to engage
these resources.
Themes
•
Misconceptions about risk on multiple levels. Misunderstandings on how easy it is to get addicted
and how hard to recover. Misconceptions about the scope of the problem, especially related to a belief
the problem occurs primarily among lower sociodemographic groups. Many community members have
differing perceptions of the signs and symptoms of use.
•
Access to heroin occurs through dealers, theft, family, friends, schools, work places, and other social
outlets. Law enforcement may play a role in preventing access by tracking large dealers in the market.
•
Community strengths include education and outreach efforts. The opiate treatment program provides
integrated behavioral health treatment for opiate addictions.
•
Community challenges include lack of cooperation between treatment providers, need for
rehabilitation housing, community controversy of treatment center locations, and a lack of transitional
housing. There is a recognition of the issues surrounding incarceration, transition, and release
associated with heroin use due to the jails located in the Mat-Su. However, there are still underserved
populations around heroin use including youth, middle and upper class, and outlying areas of the
borough.
•
Intervention efforts may be necessary before true prevention can occur.
•
Education should develop resources to clarify the misunderstanding that addiction is not a choice, but
instead it should be approached as a disease.
•
Data collection and evaluation are necessary as several efforts have begun to unfold around harm
reduction and interventions.
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Data Summary
CONSUMPTION PATTERNS
Among high school students, Mat-Su consumption patterns do not statistically differ with consumption seen
elsewhere in Alaska and in the U.S.
•
In 2015, approximately 134 high school students reported using heroin in their lifetime.
•
Alternative school students report a lifetime heroin use percentage nearly nine times higher than
traditional students (14.0 percent vs. 1.6 percent).
Table 4. Prescription Drug Misuse and Heroin Use Consumption Patterns, Mat-Su, 2015
Percent
95%
Confidence
Interval
Estimated
Number
of
Persons
Statistical
Difference
between MatSu & Alaska
Comparison
Between
Mat-Su &
U.S.
3.1
2.0 – 4.6
134
NA
NA
Traditional High School Students
1.6
0.8 – 3.4
62

Alternative High School Students
14.0
10.9 – 17.7
62


Indicator and Population Group
Lifetime Use of Heroin
All High School Students
NA
NA: Not Available
Source: YRBS.
Between 2002 and 2011, Mat-Su persons aged 12+ reported a higher rate of lifetime heroin use (3.2 percent)
compared to the U.S. (1.5 percent).
RISK & PROTECTIVE FACTORS
Among high school adults ages 18-25:
•
42.7 percent consider heroin use a very large problem in the community.
•
72.0 percent considered using heroin once or twice in their lifetime a great risk.
•
86.0 percent considered using heroin once or twice a week a great risk.
CONSEQUENCES
•
In 2015, Mat-Su residents had 19 visits to an emergency room for heroin-related reasons.
•
Between 2009 and 2013, there was an annual average of about one death per year due to heroin.
Table 5. Prescription Drug Misuse and Heroin Use Consequences, Mat-Su, 2009-2013, 2015
Indicator
Number
(2015)
% of Total Mat-Su
Resident Discharges
19
Total Deaths
(2009-2013)
7
.06
Average Annual
Deaths Per Year
1.4
Heroin (2015)
Heroin-Related ED Discharges
Indicator
Heroin Deaths (2009-2013)
Source: HFDR and CDC WONDER.
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Community Factor
•
Perceived Risk of Heroin Use: Key issues around perceived risk of harm:
o
Parent/Caregiver: Lack of education on the issue, an unawareness of child activities, and parent
denial.
•
o
Individual level: People do not think addiction or problems with heroin will ever affect them.
o
Community: Sees heroin use as a high risk, but only in certain groups/populations.
Social Availability: Key issues associated with social availability of heroin included:
o
Accessibility/low cost
o
At-risk youth not identified and are falling through the cracks
o
Lack of law enforcement
Prevention Resources
At the time of this report, this grant was the only effort in the Mat-Su focused on primary prevention of
prescription drug misuse and heroin use.
Recommendations and Next Steps
These recommendations and next steps evolved from reviewing current conditions in the Mat-Su, attending
and facilitating coalition meetings, and discussions with THRIVE staff.
Community-Level Recommendations and Next Steps
•
Work within the appropriate legal and policy process to establish permanent drop off locations for
excessive prescriptions drugs.
•
Develop a media campaign, leveraging successful national media campaign methods, to shift risk
perception and misinformation around prescription drug misuse across all age groups.
•
Focus majority of efforts on the prevention of prescription drug misuse as this misuse is often a
predictor of heroin use.
•
Develop targeted prevention strategies to dispel myths only certain populations are a risk for
prescription drug misuse or heroin use.
•
Build upon strengths of being rural and close-knit community connectedness to reduce use. Seek out
nationally-tested environmental prevention strategies used in other rural areas and adapt them to
Alaska.
Long-Term Community Recommendations and Next Steps
•
Continue tracking data presented in this report.
•
Continue to build data capacity for collecting, sharing and routinely reporting data on prescription drug
misuse and heroin use.
o
Collect treatment data to complement or supplement other population-level data collected in
this report. This, and the shared experiences of coalition members, may capture a broader
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perspective of the prescription drug misuse and heroin use to allow for different prevention
strategies.
•
Establish relationships within the Emergency Response system locally and draw upon national efforts
to better capture the impact of this issue.
o
Initiate efforts to better define emergency department definitions, coding, and reporting.
o
Work with local providers to understand how they are coding these issues within the emergency
department.
o
Consider looking nationally to see if there are efforts to increase the coding of prescription
drug misuse and heroin.

Are there already created best practices?

Are there national standards that could be implemented locally or statewide for
recognizing prescription drug misuse?

Are there other rates of emergency department visits that should be captured rather
than poisonings alone?

A local provider recommended calculating the abscesses cleaning rate in the arm as a
signal of heroin use.
o
Initiate efforts within Mat-Su Borough Emergency Response system to better capture
prescription drug misuse and heroin.

Research national standards that could serve as a potential model across the 911
system and the response data systems. Work with Emergency Response to implement
a model tailored for the Mat-Su.
o
Consider working with the Mat-Su Regional Medical Center to better understand how these
patients are being coded. This includes chart review and key stakeholder interviews.
o
Over the life of the grant, work to obtain local level emergency department data.
Long-Term Statewide Recommendations
•
Support the recommendations from the Alaska Opioid Task Force.
o
THRIVE Mat-Su should consider a multi-level strategy to engage, advocate, and provide
community level perspectives to policy makers around the Governor’s bill to combat opioid
abuse (House 159 and Senate 79).
o
THRIVE Mat-Su coalition should consider reviewing this and identifying community level efforts
to work towards for some of the recommendations.
•
Consider the use of prescription drug monitoring program (PMPD) data to inform public and
communities local level prevention activities.
o
THRIVE Mat-Su should consider advocating legislatures and leaders that the PMPD can also be
used for standard community level reports of the data. Work towards establishing these data
as part of standard public health practice reporting along with the prevalence of diabetes,
alcohol uses, injuries, and heart disease to develop environmental prevention strategies. Work
with legislators and other leaders to acquire and report these data in meaningful ways at the
community level for prevention planning. Data focus should be:

Who compose most subscribers by type?
•
Are these physicians, master-level nurses, veterinarians or others providers?
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
What is the age distribution of individuals receiving prescription opioids?

What is the distribution of the “high-utilizers” of prescriptions compared to the general
population?
•
How many people are the high-utilizers?

Average prescription rate per resident.

Geography – Where are people obtaining the prescription drugs?
•
Are people driving to Anchorage and accessing providers here?

Total number of doses dispensed in the community by year.

Total number of prescribers in the community and total number of patients receiving:
•
Average Quantity per Prescription
•
Average MED per prescription

Average distribution by month of year to understand season trends.

Percentage of prescribers enrolled in the PDMP.

Rate of multiple provider episodes and doctor shopping across the state by Mat-Su
residents.
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Introduction and Background
THRIVE Mat-Su contracted with McDowell Group to conduct a community needs assessment that presents a
picture of prescription opioid misuse and heroin use in the Mat-Su Valley. The assessment serves as a baseline
and comprehensive description of information available on the issue. It reviews national literature, compiles and
reports available epidemiologic data, summarizes results of a survey on the community’s readiness to act on
the issues, describes available prevention resources, and prioritizes key factors impacting the issues. The target
population for these prevention efforts is Mat-Su youth and adults ages 12 to 25. The assessment is intended
to support the Substance Abuse Prevention Framework (described later in this section).
Figure 1. Components of THRIVE Mat-Su Community Needs Assessment
Source: McDowell Group
THRIVE Mat-Su
THRIVE Mat-Su, a substance use prevention coalition, supports healthy lifestyles and drug free alternatives. The
coalition aims to reduce substance abuse among youth and adults in the Mat-Su Valley. The coalition includes
a range of stakeholders who meet monthly.
United Way of Mat-Su staffs and coordinates the coalition. Several grants fund the coalition, including a
Strategic Prevention Framework - Partnerships for Success (SPF-PFS) grant that supports THRIVE Mat-Su’s
efforts to prevent prescription opioid misuse and heroin abuse.
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Partnerships for Success Grant
Nationally, the Substance Abuse and Mental Health Services Administration (SAMHSA) funds Strategic
Prevention Framework - Partnerships for Success (SPF-PFS) grants supporting prevention of underage drinking
among persons 12 to 20 years of age and prescription drug misuse and abuse among persons 12 to 25 years
of age. These funds aim to strengthen community capacity for early prevention through evidence-based
community level strategies that impact the prevention system, policies, and infrastructure.
Based upon review of the data and statewide resources, Alaska chose to focus these funds towards prevention
of prescription opioid misuse and heroin use. The grant funded six communities to build local-level prevention
capacity on the issues starting in 2016 for four years.
Strategic Prevention Framework
SAMHSA developed the Strategic Prevention Framework (SPF) for communities to plan, implement, and
evaluate community-level prevention strategies. This community needs assessment supports THRIVE Mat-Su’s
assessment phase of the Strategic Prevention Framework.
The steps of the SPF include:
1. Assessment: Collecting, reviewing and prioritizing data, determining community readiness to
address specific issues, and identifying available prevention resources.
2. Capacity: Engaging available community resources to raise awareness, strengthen relationships,
and prepare prevention staff to act.
3. Planning: Establishing a community’s theory of change, through identifying and selecting
evidence-based interventions, creating logic models, and writing a strategic plan.
4. Implementation: Putting the strategic plan into action.
5. Evaluation: Assessing the effectiveness of the strategies: Were the right people engaged? Were
the right strategies used? Did community-level outcomes change?
Figure 2. Steps of Strategic Prevention Framework
Source: SAMHSA
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Other important SPF Framework characteristics include:
•
Communities integrate sustainability and cultural competency at all steps of the process.
•
Data drives the process and each phase incorporates data tracking and evaluation.
•
The process focuses on population-level change and policy, systems and environmental strategies.
•
The circular process allows for community growth and change so communities can reassess and address
additional community needs.
•
Community networks and collaboration provide the foundation for effective work.
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Methodology
This assessment draws on a variety of sources, including: secondary data sources; qualitative data from
meetings, radio shows, and other forums; results of a community readiness survey; and a prevention matrix
developed by THRIVE Mat-Su. Each method used is described below.
Methods
Secondary Data Sources
The secondary data presented in this report was compiled from several data sources. Appendix C contains a
detailed description of the sources.
•
Alaska Department of Labor and Workforce Development (DOLWD)
•
American Community Survey (ACS)
•
Centers for Disease Control and Prevention WONDER (Wide-ranging ONLine Data for Epidemiologic
Research)
•
Health Facilities Data Reporting Program
•
National Poisoning Data System
•
National Survey on Drug Use and Health (NSDUH)
•
Youth Risk Behavior Survey (YRBS)
•
Young Adults Substance Use Survey (YASUS)
Qualitative Data
Using several sources, qualitative data was reviewed and summarized by themes:
•
Drugs and Alcohol in Mat-Su Panel Discussion Summary on November 15, 2015
•
Alaska Wellness Summit: Conquering the Opioid Crisis Presentations on August 4, 2016
•
Community Meeting Minutes hosted by THRIVE Mat-Su throughout 2015
•
Stakeholder Interviews that evolved from THRIVE Mat-Su discussions of preliminary Community Needs
Assessment results
•
Opiate Epidemic Radio Show transcript provided by THRIVE Mat-Su
Community Readiness Survey
THRIVE Mat-Su staff assessed the community’s readiness for prevention efforts on prescription opioid misuse
and heroin use using the Community Readiness for Community Change Tool. Using the tool, from the Tri-Ethnic
Center for Prevention Research, THRIVE Mat-Su scored each readiness survey based upon the following
readiness levels. The prescription opioid community readiness survey received 78 responses and the heroin
readiness survey received 32 respondents.
Links to the Community Readiness Survey were sent via community partners: Palmer Chamber of Commerce,
Wasilla Chamber of Commerce, United Way of Mat-Su health and social services agency list, the Mat-Su Opioid
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Task Force, churches, and Mat-Su residents who attended the Summit (a gathering focused on prescription drug
misuse and heroin use). Additional questions were added to the survey to illicit open-ended responses
regarding community conditions, availability and perception of harm.
Readiness
Level
Table 6. Readiness Level and Readiness Stage
Stage
Community Readiness Stage
1
Community tolerance/no
knowledge
The issue is not recognized as a problem.
2
Denial
Some community members recognize it as a problem, but, the general public
does not.
3
Vague Awareness
Community knows it is a problem and something should change, but little
motivation exists to make change. A leader has not been identified to lead
the change and the community knowledge of the issue is limited.
4
Pre-planning
Most community members know it is a problem and something should
change. Community members have access to the general information, but a
clear plan for action or next steps does not exist at this stage.
5
Preparation
Community begins planning basing information on prevention strategies and
decisions about resources in terms of time, money, and people are being
identified. Generally, quantitative data is not available at this stage.
6
Initiation
Communities begin collecting a range of data and compiling it. Enough data
is available to establish the problem to guide and support strategies.
Community actions occur. Staff and leaders are aware and support the
process.
7
Initialization
Planned strategies and efforts have started and supported by community
leaders. The strategies and activities are running, the right people have the
right resources. Evaluation of the strategies begins.
8
Confirmation/Expansion
All strategies and activities run and community members participate. The
strategies have been evaluated and revised if necessary. Data is collected
systematically.
9
Professionalism
Community knows about the problems in depth. All programs and strategies
are in place. Ongoing evaluation occurs and community involvement is high
at all stages.
The questions were grouped by dimensions identified in the following table. Each question receives an average
score.; then the average of the questions associated with each dimension are averaged. This ends with an
average score for each dimension often referred to as the readiness levels.
Table 7. Readiness Level and Readiness Stage
Dimension
Description
Community Knowledge of Efforts
Community knowledge of current program and activities
Leadership
Community leadership’s attitude about addressing the issue
Community Climate
General community members attitude about addressing the issue
Community Knowledge of Issue
Community member’s knowledge of the issue
Resources
Resources available in the community currently used or potential
resources that could be used to address the issue
In addition to the community readiness score, open-ended responses to the Community Readiness Survey
Assessment were reviewed for themes to provide additional context and use for the information solicited in the
survey. Appendix F contains detailed description of the agencies surveyed and the distribution of responses by
gender, age, geography, respondent type, and race/ethnicity.
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Community Factors
In mid-January 2017, 13 members of the THRIVE Mat-Su coalition representing 11 organizations, participated
in an hour-and-a-half session facilitated by McDowell Group. The coalition received planning materials in
advance of the session, including an explanation of the session goal, definitions of relevant terms, and an
overview of the SPF. At the beginning of the session, the presenter provided a brief overview of the grant.
Preliminary findings from the data profile were then reviewed and discussed with the group to provide context
for prioritization of community factors. The remainder of the session was dedicated to facilitated small and large
group activities designed to elicit and prioritize community factors related to prescription opioid misuse and
heroin use in the Mat-Su community. Ideas for strategies, additional data sources, and key informants were also
collected; however, this was not the focus of the session.
Coalition members spent approximately 15 minutes brainstorming community factors and recording them on
a large answer sheet. Next, working in small groups, coalition members identified themes associated with the
community factors and compiled a complete list of defined community factors. A member of each small group
presented to the large group. The final exercise involved each coalition member prioritizing three factors related
to each intervening variable. These votes were compiled by the contractors. Results are summarized in the
Community Factors section of each substance use chapter.
Methods for Prevention Matrix
THRIVE Mat-Su reviewed all programs and strategies in the Mat-Su. As a coalition, they categorized the
programs by where the program would fall in a social ecology theory of change at the individual, family, school,
community, and state levels.
Then, coalition members identified each program’s place on the continuum of care for behavioral health using
the following categories:
•
Universal
•
Selected
•
Indicated
•
Prevention
•
Intervention
•
Treatment
•
Recovery
•
After-Care
Finally, the coalition identified if a program/strategy is evidence based (Yes/No) and if it focuses on asset
building.
As prevention is the focus of this Community Needs Assessment, all programs identified in the matrix as
prevention resources were reviewed for a specific focus on prescription opioid misuse and/or heroin use
prevention efforts for youth 12 to 25 years of age.
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This review did not focus on treatment resources or harm reduction resources available in the Mat-Su. The study
team relied on a range of secondary resources to identify programs including program and organizational
websites.
Community Needs Assessment Structure
This community needs assessment begins with a community landscape chapter describing community
demographics and other socioeconomic indicators focused on youth and adults ages 12-25 where possible.
Then, the report has a chapter on prescription opioid misuse and heroin use. Then, the report summarizes
prevention resources available in the community.
Each substance use chapter starts with results of a literature review describing factors influencing substance
use. Then, the results of the community’s readiness to address the issue are summarized. Next, the chapters
describe the problem by consumption patterns, consequences of consuming, and risk and protective factors.
The substance use chapters conclude with a summary of themes that emerged from a community meeting
where coalition leaders identified important community factors related to the substance.
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Technical Notes
Acronyms
The following table contains a list of acronyms used throughout the report.
Table 8. Acronym List and Definitions
Acronym
Definition
ACS
American Community Survey
AN/AI
Alaska Native and/or American Indian
BRFSS
Behavioral Risk Factor Surveillance System
CDC WONDER
Centers for Disease Control and Prevention Wide-ranging ONLine Data for Epidemiological Research
DBH
Division of Behavioral Health
DEED
Alaska Department of Education and Early Development
DHSS
Alaska Department of Health and Social Services
DOLWD
Alaska Department of Labor and Workforce Development
ED
Emergency Department
HFDR
Health Facilities Data Reporting Program
HRSA
Health Resources and Services Administration
MSB
Mat-Su Borough
MSBSD
Mat-Su Borough School District
NMUPO
Non-medical use of prescription opioids
NPDS
National Poisoning Data System
NSDUH
National Survey on Drug Use and Health
PDMP
Prescription Drug Monitoring Program
PFS
Partnerships for Success
SAMHSA
Substance Abuse and Mental Health Services Administration
SPF
Strategic Prevention Framework
SPF-PFS
Strategic Prevention Framework-Partnerships for Success
YASUS
Young Adult Substance Use Survey
YRBS
Youth Risk Behavior Survey
Definitions
Report Terminology
Throughout this report, the term “prescription opioid misuse” is used. This is sometimes referred to as NMUPO
(Non-Medical Use of Prescription Opioid) or prescription pain medicine.
NMUPO: Non-medical use of prescription opioids
Social availability of prescription opioids: Availability and accessibility of prescription opioids through social
sources
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Retail availability of prescription opioids: Availability and accessibility of prescription opioids through
providers (including but not limited to physicians, masters-level nurses, dentists, veterinarians) or dealers
Perception of risk for harm: Degree to which a person thinks of opioids and heroin as potentially dangerous
Consumption Patterns: Measures of alcohol, tobacco, and/or other drugs use
Risk & Protective Factors: Events, beliefs, or experiences which influence both the consumption of substances
and the consequences of using and/or abusing these substances
Consequences: Negative events or experiences that result from substance use
Middle School Students: 7th-8th grade students
High School Students: 9th-12th grade students
Data Notes
Data Limitations
Many of the datasets presented in this report have their own unique limitations, described below. Additionally,
the entire collection of data poses another challenge due to its disparate nature that limits comparisons between
datasets, over time, and by age group. Overall, a lack of coherent and recent data hinders a comprehensive view
of the present state of heroin use and prescription opioid misuse in Mat-Su.
CDC WONDER
The cause of death data retrieved from this data source only captured numbers at the county/borough-level for
counties and boroughs with five-year death counts exceeding 20. It is possible to query the dataset for
information at the state and national level, but the criteria used for the initial query of county/borough-level
data were never provided to allow for replication. As such, statewide and national comparisons were not
available.
HEALTH FACILITIES DATA REPORTING PROGRAM
The State of Alaska provided the number of Emergency Department (ED) discharges due to: any heroin-related
reason, heroin poisoning, any prescription opioid-related reason, and prescription opioid poisonings. These
counts were determined by querying ICD-9 and ICD-10 codes (see Appendix C for a list of those codes).
Problems with this methodology arise because patients often present to the ED not for drug use but because
of the medical problems that result from drug use. Consequently, physician coding may indicate the medical
problem treated but not its relation to drugs. Examples of conditions commonly related to drugs, especially
heroin and prescription opioids, include mental disorders, suicide, abscess, bacterial infection, hypoglycemia,
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trauma injuries, acidosis, respiratory arrest, and respiratory depression, among others 1,2. One study of the
prevalence of adverse drug events (unintended symptoms of abnormal lab work from either appropriate or
inappropriate use of prescription or over the counter drugs) found coding in the emergency department
captured just 6.8 percent of adverse drug events that actually occurred. 3
NATIONAL SURVEY OF DRUG USE AND HEALTH
The National Survey of Drug Use and Health (NSDUH) dataset represents a ten-year period between 2002 and
2012, which does not allow for trends over time. It does not capture recent years. NSDUH addresses all people
ages 12+, including not only the target population (12-25) but older adults as well.
YOUTH RISK BEHAVIOR SURVEY
The middle school and alternative, traditional, and all high school Youth Risk Behavior Survey (YRBS) data came
in different years with different demographic breakouts. The disparate nature of the data hinders comparison
and analysis. Middle school data is only in Mat-Su and Statewide. It includes breakouts by gender and
race/ethnicity but is limited to a single year. Data on traditional high schools in Mat-Su comes from three years
and includes demographic breakouts. However, those demographic breakouts were available only for Mat-Su
and not statewide or nationally. There are three years of alternative high school data for Mat-Su and statewide,
but demographic breakouts are only for Mat-Su. Similarly, data on all high schools (alternative and traditional)
does not include national figures. Also, all high school data does not include gender comparisons. See Appendix
C for a table summarizing the years and demographic data available for each set of YRBS data.
Further limitations arise when estimating the number of students affected by indicators. This estimation is a
function of both prevalence rates and school enrollment. School classifications (e.g. traditional or alternative)
change year to year which affects the enrollment totals for alternative and traditional schools. Consequently,
the estimated number of affected students changes because of variation in not only prevalence but enrollment
as well. Changes in the estimated number of affected students may not reflect changes in the total number of
affected students.
YOUNG ADULT SUBSTANCE USE SURVEY
The Young Adult Substance Use Survey (YASUS) began in 2016 and provides just one year of data. In Mat-Su,
the 143 individuals that completed YASUS represent 1.4 percent of the region’s estimated population of 9,679
of individuals ages 18-25 in 2015. The sample size for some questions were even smaller than 143. Such small
sample sizes limit the ability to consider YASUS prevalence rates as representative of the entire Mat-Su
population.
http://emedicine.medscape.com/article/166464-clinical
Slavova, S., Bunn, T. L., & Talbert, J. (2014). Drug Overdose Surveillance Using Hospital Discharge Data. Public Health Reports, 129(5), 437–
445.
3 Hohl, C. M., Kuramoto, L., Yu, E., Rogula, B., Stausberg, J., & Sobolev, B. (2013). Evaluating adverse drug event reporting in administrative
data from emergency departments: a validation study. BMC Health Services Research, 13, 473. http://doi.org/10.1186/1472-6963-13-473
1
2
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TREATMENT DATA
A data request was submitted to the Division of Behavioral Health (DBH) for outpatient treatment data from
DHSS’s Alaska Automated Information Management System, its behavioral health electronic health record
database. At the time of publishing, DBH had not yet provided the data or indicated the possibility of providing
it. Although this report focuses on prevention, treatment data indicates the scope of opioid and heroin
dependence in Mat-Su. The number of patients receiving treatment or in need of treatment defines the
magnitude of the problem that must be addressed.
Statistical Difference Key
This key is used in the Consumption, Consequences, and Risk and Protective Factors data sections.
Table 9. Symbols for Statistical Comparison
Symbol
Comparison Indication

Indicates there is a statistical difference between the Mat-Su and the region compared, and the
Mat-Su percent is better than the comparison percent.

Indicates there is not a statistical difference between the comparisons.

Indicates a statistical difference between the Mat-Su and the region compared, and the Mat-Su
percent is worse than the comparison percent. Reference Group is higher than the other group.
NA
Indicates the data are not available for this comparison.
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Community Landscape
Current Population and Age Groups
In 2015, an estimated 100,178 residents lived in the Mat-Su Borough, approximately 14 percent of the state’s
total population. 4 Of the total Mat-Su population, 18.6 percent were age 12-25 years (18,662 residents). The
Mat-Su median age was 35.1 years.
Table 10. Mat-Su Borough and Alaska Population, by Age Group, 2015
Mat-Su Borough
Alaska
Specified Age Group
Count
Percent
11 years and younger
18,959
18.9
127,577
17.3
12 to 17 years
8,983
9.0
59,390
8.1
18 to 20 years
3,945
3.9
29,819
4.0
21 to 25 years
5,734
5.7
53,985
7.3
26 years or older
62,557
62.4
466,854
63.3
Total population
100,178
Median age
Count
Percent
737,625
35.1 years
-
-
34.5 years
Source: DOLWD Population Estimates and McDowell Group calculations.
Gender
In 2015, an estimated 51,799 male residents lived in Mat-Su (51.7 percent), along with 48,379 female residents
(48.3 percent). For the population age 12-25 years, there were an estimated 9,831 males and 8,804 females, 52.8
and 47.2 percent, respectively.
Table 11. Mat-Su Borough and Alaska Population, by Gender, 2015
Mat-Su Borough
Alaska
Gender
Count
Percent
Count
Percent
Male
51,681
51.7
381,888
51.8
9,831
52.8
75,827
52.9
48,271
48.3
355,295
48.2
8,804
47.2
67,400
47.1
12-25
years
Female
12-25
years
Source: DOLWD Population Estimates.
Race and Ethnicity
In 2015, most of the Mat-Su population identified as white (83.5 percent), 6.5 percent identified as Alaska Native
or American Indian (AN/AI), 1.3 percent as Black or African American, 1.5 percent as Asian, 0.4 percent identified
4
DOLWD.
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as Native Hawaiian or other Pacific Islander, and 6.7 percent as two or more races. All the categories are listed
as race alone, not in combination with another race.
Table 12. Mat-Su Borough and Alaska Population, by Race Alone, 2015
Mat-Su Borough
Alaska
Race Category
Count
Percent
Count
Percent
White
83,690
83.5
491,143
66.6%
Alaska Native or American Indian
6,541
6.5
110,157
14.9
Black or African American
1,349
1.3
28,145
3.8
Asian
1,501
1.5
46,060
6.2
360
0.4
9,554
1.3
6,737
6.7
52,566
7.1
Native Hawaiian or Other Pacific Islander
Two or more races
Source: DOLWD Population Estimates.
Figure 3. Mat-Su Borough Population, by Race Alone, Percent, 2015
Asian
1.5%
Alaska Native/American Indian
6.5%
Black/African American
1.3%
Pacific Islander
0.4%
Two or More Races
6.7%
White
83.5%
Source: DOLWD Population Estimates and McDowell Group calculations.
For the borough population age 12-25 years, in 2015, most identified as white (78.4 percent), 8.4 percent
identified as AN/AI, 1.5 percent as Black or African American, 1.7 percent as Asian, 0.4 percent identified as
Native Hawaiian or other Pacific Islander, and 9.6 percent as two or more races. All the categories are listed as
race alone, not in combination with another race.
Table 13. Mat-Su Borough Population 12 to 25 Years, by Race Alone, 2015
Race Category
Count
Percent
White
16,624
78.4
Alaska Native or American Indian
1,773
8.4
Black or African American
323
1.5
Asian
366
1.7
Native Hawaiian or Other Pacific Islander
91
0.4
2,040
9.6
Two or more races
Source: DOLWD Population Estimates.
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Population Trends
The Mat-Su Borough population has grown at a faster rate than the rest of Alaska. Since 1990, the population
has increased from 39,683 to 100,178 residents, a 152.4 percent increase and a 3.9 percent annual growth rate.
Figure 4. Mat-Su Borough Five-Year Interval Population Trends, Count, 1990-2015
100,178
88,995
74,871
39,683
59,322
48,906
1990
1995
2000
2005
2010
2015
Source: DOLWD Population Estimates.
Population Projections
The Mat-Su Borough population is expected to continue increasing at a faster rate than the rest of Alaska. 5 The
Borough will have an estimated 182,836 residents in 2045, a projected 2.1 percent annual growth rate, and will
comprise approximately 20.3 percent of Alaska’s total population.
Figure 5. Mat-Su Borough Five-Year Interval Population Projections, Count, 2015-2045
100,178
113,415
127,144
141,247
155,442
169,418
182,836
2015
2020
2025
2030
2035
2040
2045
Source: DOLWD Population Estimates and McDowell Group calculations.
Economic Indicators
In 2015, median household income in the Mat-Su Borough was $72,983 6 (+/-$1,577) and per capita income was
$29,913 (+/-$679). An estimated 10.0 percent (+/-0.8 percent) of all people in the Borough were living below
the poverty line in the past 12 months. An estimated 7.0 percent (+/-0.6 percent) of households were receiving
some form of cash public assistance, and 10.7 percent (+/-0.8 percent) were receiving Food Stamps/SNAP
benefits in the past 12 months.
5
6
DOLWD 2015-2045 population projections.
ACS 2011-2015 Five-Year Estimates.
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Table 14. Mat-Su Borough and Alaska Selected Economic Indicators, 2011-2015 Five-Year Estimates
Mat-Su Borough
Alaska
Economic Indicator
Estimate
Margin of Error
Estimate
Margin of Error
Median household income
$72,983
+/-$1,577
$72,515
+/-$838
Per capita income
$29,913
+/-$679
$33,129
+/-$337
% All people whose income in the past
12 months is below the poverty level
10.0%
+/-0.8%
10.2%
+/-0.4%
% Households with cash public
assistance income
7.0%
+/-0.6%
6.3%
+/-0.3%
% Households with Food Stamps/SNAP
benefits in the past 12 months
10.7%
+/-0.8%
10.5%
+/-0.3%
Source: ACS 2011-2015 Five-Year Estimates.
Education Indicators
The Alaska Department of Education and Early Development (DEED) reported there were 18,745 students
enrolled in the Matanuska-Susitna Borough School District for the 2015-2016 school year (as of October 1,
2015). Approximately 2,765 were special education students, comprising 14.8 percent of total enrollment.
Table 15. Mat-Su Borough School District and Alaska Selected Education Indicators,
School Year 2015-2016
MatanuskaSusitna Borough
Alaska
18,745
132,966
Number of special education children
2,765
18,390
Percent of special education children
14.8%
13.8%
Indicator
Total enrollment
Source: DEED.
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Prescription
Opioid Misuse
Literature Review
The following chapter provides a brief overview of the national literature on non-medical use of prescription
opioid with an emphasis on young-adult populations between the ages of 18 and 25 years. It describes national
use patterns. Then, this chapter focuses on social, availability, retail availability, and perceived risk of harm.
Use Patterns
National data consistently documents a parallel relationship between increased legitimate usage of opioids in
the U.S. and a significant rise in non-medical use of the drugs. This data suggests that lifetime rates or
prescription opioid misuse may be as high as 24.3 percent among young adults (18 to 25 years of age). 7 Nonmedical use of prescription opioids can lead to a prescription opioid disorder, progression to heroin use, and
death. 8
Most studies of non-medical use of prescription opioids among adolescents suggest that prevalence rates are
approximately 10 percent during high school and as high as 20 percent during college. 9 The age of peak risk
for such non-medical use is 16 years old, and most use is initiated prior to 18 years of age. 10 Longitudinal
evidence from cohorts of graduating high school students suggests most non-medical use of prescription
opioids is experimental. 11 In many cases, such use shows up with use of other substances, such as alcohol,
marijuana, hallucinogens, cocaine, non-medical stimulants, and sedatives. 12
Gender
A review of factors associated with non-medical use of prescription opioids found mixed evidence of gender
differences. 13 Some studies suggest female teenagers are more likely to engage in use, while other studies
identify male adolescents as more frequent users. Male and female users do appear, however, to access
prescription opioids via different channels and for different purposes. Female adolescents are more likely to
obtain the drugs for free or by stealing from a friend or relative, while male adolescents are more likely to
purchase prescription opioids or obtain them via prescription from a provider. 14 Female teenagers are more
likely to seek prescription opioids for self-treating purposes, while young men are more likely to identify thrillseeking as their intention when using the drugs. 15 Addiction to these substances may also manifest differently
Daniulaityte, R., Falck, R., & Carlson, R. G. (2014). Sources of pharmaceutical opioids for non-medical use among young adults. Journal of
psychoactive drugs, 46(3), 198-207.
8 Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A
Review. The Yale Journal of Biology and Medicine, 88(3), 227.
9 McCabe, S. E., Schulenberg, J. E., O'malley, P. M., Patrick, M. E., & Kloska, D. D. (2014). Non‐medical use of prescription opioids during the
transition to adulthood: a multi‐cohort national longitudinal study. Addiction, 109(1), 102-110.
10 Ibid.
11
Ibid.
12
Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A
Review. The Yale Journal of Biology and Medicine, 88(3), 227.
13 State of Alaska Department of Health and Social Services. (2016). Prevention of non-medical use of prescription opioids and heroin use
in Alaska. Available at: http://www.iser.uaa.alaska.edu/Projects/pfs/docs/ PFSGuidanceDocument.pdf.
14
Ibid.
15
Ibid.
7
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by gender. One study found that men displayed behaviors such as increased alcohol abuse, use of other illicit
drugs, as well as more arrests, while women displayed symptoms of mood depression, reduced capacity for
interpersonal relationships, and decreased activity. 16
Race / Ethnicity
Research has consistently found higher rates of non-medical use of prescription opioids among white
individuals. 17
Geography
Non-medical use of prescription opioids morbidity and mortality has increased around the country, but death
and injury from use is higher in states with large rural populations, including Alaska. 18 National results indicate
that not only are death and injury rates higher in rural areas, but rural adolescents are more likely to engage in
non-medical use of prescription opioids than adolescents in urban areas. 19 Researchers hypothesize that four
issues drive increased rural use and abuse: (1) increased prescription opioid availability in rural areas, (2) outmigration of young people, (3) social and kinship networks, and (4) structural stressors of modern rural living.
While retail availability of prescription opioids has increased nationwide, per capita sales data suggest rural
areas have some of the highest prescription rates. 20 This may be caused by several factors. In some cases, directto-consumer advertising has been more aggressive in rural areas. 21 Rural populations tend to be older on
average than urban populations, which may lead to more opioid prescriptions for pain management. 22 Chronic
pain and injury occur at higher rates in rural areas, which may drive prescription rates higher. 23 In some areas,
particularly where heavy labor is common, use of prescription opioids is embedded within the culture in order
to maintain an able workforce. 24 Researchers suggest that increased retail availability of the drugs drives social
availability in rural areas.
Many rural areas have experienced an outflow of young people in recent years, which may drive higher nonmedical use of prescription opioids in two ways. Outmigration of younger populations is associated with
depressed economic conditions, which may increase vulnerability to non-medical use of prescription opioids,
and young adults who stay in rural areas may have a higher accumulation of risk factors that predispose them
to use. 25
16 Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A
Review. The Yale Journal of Biology and Medicine, 88(3), 227.
17
DHSS. (2016). Prevention of non-medical use of prescription opioids and heroin use in Alaska. Available at:
http://www.iser.uaa.alaska.edu/Projects/pfs/docs/ PFSGuidanceDocument.pdf.
18
Keyes, K. M., Cerdá, M., Brady, J. E., Havens, J. R., & Galea, S. (2014). Understanding the rural–urban differences in nonmedical prescription
opioid use and abuse in the United States. American Journal of Public Health, 104(2), e52-e59.
19 Ibid.
20
Keyes, K. M., Cerdá, M., Brady, J. E., Havens, J. R., & Galea, S. (2014). Understanding the rural–urban differences in nonmedical prescription
opioid use and abuse in the United States. American Journal of Public Health, 104(2), e52-e59.
21
Ibid.
22 Ibid.
23 Ibid.
24
Ibid.
25
Ibid.
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Social and kinship networks differ between urban and rural areas. In general, community ties tend to be stronger
in rural areas. 26 Economic strain on rural social networks may “spread” more quickly and contribute to nonmedical use of prescription opioids. 27 Likewise, strong community networks may enable individuals to access
prescription opioids more easily through social means. 28 Family structures in rural areas tend to be larger.
Stronger and larger family networks may increase the accessibility of the drugs through relatives and friends. 29
Additionally, long-term economic deprivation, high unemployment rates, fewer opportunities for long-term
employment, and limited chances for upward mobility in rural areas may create a stressful environment that
increases the likelihood of non-medical use of prescription opioids by community members. 30
Transition to Adulthood
High school graduation is a significant developmental milestone for adolescents; it also marks the point at which
many young adults begin managing their own medications. 31 A nationally representative sample of over 27,000
high school seniors followed longitudinally from age 18-26 years showed that most non-medical use of
prescription opioids among 18-year-olds appears to be experimental and ultimately cease; however,
approximately one third continued NMUPO beyond age 18, and these individuals were more likely to display
other substance abuse behaviors by ages 23 or 24. 32 The odds of past year non-medical use of prescription
opioids were significantly associated with race/ethnicity (white), truancy, binge drinking, marijuana use, and if
the adult was a senior in high school after 1991. 33 The chances of substance abuse behavior were higher among
those who reported past-year non-medical use of prescription opioids multiple times during the longitudinal
study; notably, these rates did not decrease with age, as is found with most substance abuse behaviors during
the transition from adolescence to adulthood. 34 Development of prescription opioid abuse and dependence is
more likely when initiation of non-medical use of prescription opioids begins prior to the age of 18. 35
Multiple Health Concerns
Poor health is a risk factor for non-medical use of prescription opioids. One study of a nationally representative
sample found that cardiovascular disease and all chronic physical conditions except gastrointestinal disease
significantly predicted non-medical use of prescription opioids. 36 The greater the number of physical conditions,
the more likelihood there was for non-medical use of prescription opioids abuse/dependence. 37 Mental illness
Ibid.
Ibid.
28 Ibid.
29 Ibid.
30 Ibid.
31 McCabe, S. E., Schulenberg, J. E., O'Malley, P. M., Patrick, M. E., & Kloska, D. D. (2014). Non‐medical use of prescription opioids during the
transition to adulthood: a multi‐cohort national longitudinal study. Addiction, 109(1), 102-110.
32 Ibid.
33 Ibid.
34 McCabe, S. E., Schulenberg, J. E., O'Malley, P. M., Patrick, M. E., & Kloska, D. D. (2014). Non‐medical use of prescription opioids during the
transition to adulthood: a multi‐cohort national longitudinal study. Addiction, 109(1), 102-110.
35 Ibid.
36 Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical prescription opioid use and
abuse and dependence: results from a longitudinal nationally representative sample. Drug and Alcohol Dependence, 132(1), 107-113.
37
Ibid.
26
27
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often co-occurs with non-medical use of prescription opioids. 38 The same study found that all mental disorders,
except for anxiety disorder, were significantly and positively associated with non-medical use of prescription
opioids and abuse/dependence. 39
Risk and Protective Factors
Researchers have identified numerous risk factors associated with non-medical use of prescription opioids, as
well as some protective factors that buffer against prescription opioid use. Risk and protective factors exist at
all levels — qualities or experiences at the individual level, interactions at the family level, and environmental
context at the community level—however, most risk and protective factors identified to date occur at the
individual level. 40 The following tables summarize risk and protective factors identified in a national literature
review, grouped by domain of the social ecology.
Table 16. Risk Factors for Non-Medical Use of Prescription Opioid by Domain
Risk Factors
Individual
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Lifetime medical use of prescription opioids
Early initiation
Prior history of non-medical use of prescription opioids
Family history of non-medical use of prescription
opioids
Current non-medical use of prescription opioids
Availability of prescription opioids
Perceived availability of prescription opioids
Having friends who engage in non-medical use of
prescription opioids
Having a close friend who uses substances
Obtaining drugs from a dealer
Impulsive or sensation-seeking qualities
Boredom
Wanting to ease social anxiety
Low perception of risk for NMUPO and stimulants
Social or delinquent behavior
Frequency of participation in risky behaviors
Normative alcohol beliefs 41
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Alcohol and illicit drug use
Sexual activity and risky sexual behavior
Criminal history
History of school suspension
History of traumatic events
Socioeconomic status 42
Living in rural areas
Older students in high school and college
Unmarried
Mental health status
Diagnosis of depression within last 2 years
Fair to poor health
Lower college GPA
Low academic performance
Low school bonding
Fewer years of education
No intention to attend or complete college
Member of fraternity or sorority
ER use
Family
•
•
Parent attitudes towards drug use
Conflict with parents
•
•
Peer drug use
Peer attitudes towards drug use
•
Detached parents
Community / Environment
•
•
Rural area social and economic characteristics
Availability of drugs among peers
Source: SAMHSA (2013). Risk and protective factors associated with nonmedical use of prescription drugs. Center for Application of
Prevention Technologies.
38 Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A
Review. The Yale Journal of Biology and Medicine, 88(3), 227.
39 Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical prescription opioid use and
abuse and dependence: results from a longitudinal nationally representative sample. Drug and Alcohol Dependence, 132(1), 107-113.
40 SAMHSA (2016). Preventing prescription drug misuse: understanding who is at risk. Center for Application of Prevention Technologies.
41 Beliefs or attitudes that alcohol abuse is normal.
42
Both low and high socioeconomic status are associated with NMUPO in different populations.
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Table 17. Protective Factors for Non-Medical Use of Prescription Opioids by Domain
Protective Factors
Individual
•
•
•
•
No prior history of non-medical use of prescription
opioids
Perceived popularity
Impulse control
Frequency of participation in prosocial behaviors
•
•
•
•
•
Friends engage in prosocial behaviors
School attendance Commitment to school
Lack of Criminal history
Proper medication management for ADHD
Social engagement
Family
•
•
Parental disapproval of non-medical use of
prescription opioids
Living in a two-parent household
•
•
•
Social bonding within the family
Parental bonding
Parental knowledge of child’s companions
Community / Environment
•
Norms against non-medical use of prescription
opioids among youth
Source: Compiled from the following sources: SAMHSA (2013). Risk and protective factors associated with nonmedical use of prescription
drugs. Center for Application of Prevention Technologies. SAMHSA (2016). Preventing prescription drug misuse: understanding who is at
risk. Center for Application of Prevention Technologies.
Most At-Risk
SAMHSA recently published a report identifying individual, relationship, and community level factors that make
individuals most at risk for non-medical prescription drug use. Those with a history of mental illness, acute or
chronic pain, physical health problems such as headaches or fatigue, heightened physiological response to
some drugs, and a history of substance abuse or misuse are most at risk. 43 Relationship-level risk factors that
increase the chance of non-medical use of prescription drugs among adolescents include: parents who express
positive attitudes towards substance use, witnessing a family member overdose, initiating use of prescription
drugs early and at home, associating with friends who misuse prescription drugs, and participating in some
social networks (such as fraternities and sororities). Several aspects of the community setting—such as
urbanicity, residential mobility, and the experience of discrimination—were also linked with high-risk of use. 44
Social Availability
Social availability describes the accessibility and availability of prescription opioids through social sources, such
as family and friend networks. Research shows that most adolescents obtain prescription opioids from friends
for free or from their own left-over prescriptions. 45 A study of non-dependent, college student prescriptionopioid-users indicated that prescription opioids are so pervasive that young adults need not leave their
immediate social circles to access them. 46 Young adults described two distinct patterns for obtaining the drugs:
some engage actively in obtaining prescription opioids by seeking them out or buying them, while others obtain
the drugs more passively when prescription opioids are offered or shared for free. 47 Individuals are most likely
SAMHSA (2016). Preventing prescription drug misuse: understanding who is at riks. Center for Application of Prevention Technologies.
Ibid.
45 McCabe, S. E., Schulenberg, J. E., O'Malley, P. M., Patrick, M. E., & Kloska, D. D. (2014). Non‐medical use of prescription opioids during the
transition to adulthood: a multi‐cohort national longitudinal study. Addiction, 109(1), 102-110.
46 Daniulaityte, R., Falck, R., & Carlson, R. G. (2014). Sources of pharmaceutical opioids for non-medical use among young adults. Journal of
Psychoactive Drugs, 46(3), 198-207.
47
Ibid.
43
44
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to engage passively for the purposes of self-medication, while young adults who engaged actively in obtaining
prescription opioids are more likely to use the drugs recreationally. 48
In addition, the study found: 49
•
Young adults sometimes obtain drugs for parents for “justifiable” reasons (like self-medication) but not
for recreational use.
•
Stealing prescription opioids from parents was only infrequently reported.
•
Young adults indicated they rarely sought out prescription opioids via providers, because they are easier
and less expensive to obtain from illegal sources.
•
Nevertheless, many young adults engage in non-medical use of prescription opioids by using their own
left-over prescriptions.
•
Most respondents had received prescription opioids for free at least once from friends or others in their
social network.
•
Buying prescription opioids was the most common way young adults had accessed the drugs in the last
month.
Retail Availability
Retail availability refers to the availability and accessibility of prescription opioids through providers (including
but not limited to physicians, masters-level nurses, dentists, veterinarians) or dealers.
Providers
Rates of overdoses are proportional to rates of prescriptions. 50 There is noted variation in opioid prescription
patterns. This likely results from several factors, including:
•
Increased attention to “pain as the fifth vital sign.”
•
Over-reliance on prescription opioids to treat pain.
•
Direct-to-consumer pharmaceutical advertising.
•
Introduction of pain management guidelines and new pain medications.
•
Deficits in provider training on pain management, addiction screening, and addiction treatment. 51
Dealers
A study of availability of prescription opioids among college students identified several types of dealers
including regular dealers who travel to other states to obtain drugs, sporadic sellers who sell their unused
prescription drugs to make money, and individuals who function as a middle man to make extra money or cover
Ibid.
Ibid.
50 Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical prescription opioid use and
abuse and dependence: results from a longitudinal nationally representative sample. Drug and Alcohol Dependence, 132(1), 107-113.
51
Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription Opioid Use Disorder: A
Review. The Yale Journal of Biology and Medicine, 88(3), 227.
48
49
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their own use. 52 No matter the type of dealer, he or she is often also a friend, co-worker, or relative of the
buyer. 53 Dealers describe interacting with friends or relatives to sell prescription opioids as preferable, because
of the additional trust and safety this provides. 54 The same study found prescription opioids are easy to sell and
are sometimes bartered for goods or services (like home repairs). 55
Prescription Drug Monitoring
The availability, access, and use of Prescription Drug Monitoring Programs impact social and retail availability.
Prescription drug monitoring programs (PDMP) track the prescribing and dispensing of certain controlled
medications, like opioid pain relievers. Providers and pharmacists who prescribe and dispense controlled
medications may report to a central database. The databases provide two benefits, both of which impact the
retail and social availability of prescription opioids. The first comes in the form of real-time analysis. Prior to
prescribing, providers access PDMPs to learn about the history and patterns of patient medication use. In New
York and Tennessee, a requirement that prescribers check the PDMP prior to prescribing resulted in a 75 percent
and 36 percent drop, respectively, in patients seeing multiple prescribers for the same drugs within a year 56.
The second benefit of PDMPs comes in the form of retroactive analysis, which elucidates the factors contributing
to community prescription opioid abuse. Retroactive analysis provides details at three levels: patient, provider,
and prescription. At the patient level, useful indicators include the number people who exhibit “doctor
shopping” behavior and the number of people receiving high dose prescriptions. For providers, useful indicators
answer which providers and specialties are prescribing the most controlled medications. With regards to
prescriptions, PDMPs can tell the number of prescriptions filled per population, median day of prescription
supply, and the number of high dose prescriptions filled. The PDMP also enables geographic analysis such as
where people are getting their prescriptions.
Currently, Alaska’s PDMP does not allow for both real-time and retroactive analysis. Regarding real-time
analysis, state statutes do not require providers to review the PDMP prior to prescribing prescription pain
medication: participation is voluntary. Additionally, reporting occurs monthly so that if providers do decide to
review the PDMP, they do not always have access to current data. As for retroactive analysis, historically, the
PDMP has not been open to public health analysis other than the annual evaluation reports submitted to the
governor. SB74, enacted in 2016, opened PDMP for public health and epidemiologic purposes only to
authorized” employees of DHSS. Data available for analysis can include the region of a patient, prescriber, or
pharmacy and the specialty of the prescriber but may not disclose their identity.
Daniulaityte, R., Falck, R., & Carlson, R. G. (2014). Sources of pharmaceutical opioids for non-medical use among young adults. Journal of
Psychoactive Drugs, 46(3), 198-207.
53 Ibid.
54 Ibid.
55
Ibid.
56
https://www.cdc.gov/drugoverdose/policy/successes.html
52
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Perception of Risk for Harm
Opioids
Perception of the risk for harm refers to the degree to which an individual identifies prescription opioids use as
potentially dangerous. Young-adult, non-dependent users draw upon several pieces of information when
assessing the risk of drugs and the degree to which those risks can be managed including: potential for
addiction, overdose or death; organ damage; uncontrollable highs; harm to the brain; and other factors such as
routes of administration, acceptability of use, and personal vulnerability. 57 Young-adult, non-medical users of
prescription opioids assess the risks of addiction to and overdose and death from pain medications as relatively
low compared to other drugs, and in general they assign the risks to users who are not careful about their use. 58
Organ damage, uncontrollable highs, and brain damage from non-medical use of pain medication are not
identified as serious concerns. 59 Injection of pain medication is associated with a greater perception of risk. 60
Perception of risk for harm from prescription opioids is mitigated by the legitimacy conferred on the drugs
because they are prescribed substances; in the words of one study participant “I mean…a doctor prescribes
them to you…can’t be that bad.” 61 Some individuals indicated they feel invulnerable to pain medications, while
others described specific management tactics to mitigate risks (knowing their limit, obtaining drugs from
specific sources, avoiding mixing medications with alcohol use, and even reduction in consumption). 62 The most
homogenous perceptions of risk of harm from various drugs are held by those with fewer drug experiences; as
individuals engage in more frequent drug use, their views become more idiosyncratic. 63
Ibid.
Ibid.
59 Daniulaityte, R., Falck, R., & Carlson, R. G. (2012). “I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk
among illicit users of pharmaceutical opioids. International Journal of Drug Policy, 23(5), 374-384.
60 Ibid.
61 Ibid.
62 Ibid.
63
Ibid.
57
58
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 35
Community Readiness Results
This section summarizes results from the Community Readiness Survey specific to prescription opioid misuse.
Results include those from scoring and key themes that emerged from the open-ended responses.
Community Readiness Score
Scores from the survey assess the readiness of the Mat-Su community on prescription opioid misuse ranging
from one to nine, including an average of 2.52 on community knowledge of efforts, 2.83 on leadership, 4.00 on
community climate on the issue, 2.90 on community knowledge of the issue, and 2.86 on resources knowledge.
Table 18. Prescription Drug Community Readiness Scoring Results
Domain
Average
Common Themes Identified in Scoring Process
Community
Knowledge of Efforts
2.52
Unaware of efforts, groups seem to be self-interested, lack of knowledge.
Leadership
2.83
Aware of issue but with the lack of the community support they are hesitant
to do anything.
Community Climate
4.00
Concerned by the negative media, know that it is a problem but are
unaware of what they can do.
Community
Knowledge of Issue
2.90
Unless they are personally affected they do not know where to start on the
problem, what to do, or that they can do to help.
Resources
2.86
Aware that there are resources but have no idea where they are or the
process of helping with the problem.
Community Readiness Responses Themes
In the Community Readiness Survey, there are many open-ended responses to support an assessment. This
section summarizes the themes that emerged from respondents.
General Summary
Strong concern in Mat-Su about prescription opioid addiction has resulted from the increase in crime and
fatalities related to opioid use. Most opioid abuse starts with prescribed pain medication and can affect
individuals of all ages and backgrounds. Increased media attention on this issue has also contributed to
increased community concern.
ACCESS
Community members cite easy access in home medicine cabinets to this highly-addictive and potentially deadly
substance as a concern and because misuse of opioids is where most heroin use begins. Aside from doctors,
community members acquire opioids through several other sources, including hospice, family, friends, schools,
work places, and other social outlets. Dealers and theft are additional sources. To prevent access, community
members have several ideas, including establishment of a database to monitor prescriptions and prescribers.
Drug disposal opportunities, law enforcement and legalization of THC for pain are other thoughts.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 36
MISCONCEPTIONS
Current misconceptions among community members about prescription opioid misuse include a
misunderstanding about how individuals obtain opioids and how easy it is to get addicted to them. Most opioid
abuse starts with prescribed pain medication and can affect individuals of all ages and backgrounds. There is
also a lack of understanding of the link between pain medication and heroin, as opioids may be viewed as safe
because they are prescribed by doctors. Also, a common misperception is that only low-income, less educated,
or homeless individuals are involved with opioid misuse, whereas this issue impacts all populations including
seniors. Also, the issue carries a stigma that considers addiction as a character flaw, or a result of bad parenting,
rather than as an illness and a frequent result of ACES.
COMMUNITY STRENGTHS
Strengths in current community efforts to address prescription opioid misuse include peer-to-peer support
programs, treatment centers, community and physician education, media coverage, prevention activities, and
THRIVE Mat-Su’s and the Opiate Task Force’s work.
COMMUNITY CHALLENGES
Community challenges to address the issue include lack of funding and understanding of addiction, as well as
need for long-term residential treatment and rehabilitation housing. Need to focus efforts beyond youth and
treatment providers is also mentioned. Underserved populations include youth, laborers, low-income, people
in pain, people who need help at night, seniors, and the population in outlying areas of the borough.
EDUCATION
Education on the issue is occurring through social media, as well as other media outlets, opioid task force
meetings, and presentations, including at schools and clubs. Word of mouth and personal experience is all
continuing to education members of the community. Education for the community, patients, and doctors is
viewed as important, as well as better screening for medication need and follow up after prescription of drugs.
Education and treatment are important prevention and intervention measures to increase in Mat-Su.
COMMUNITY AWARENESS
Strong concern in Mat-Su about prescription opioid addiction is generated through the increase in crime and
fatalities related to opioid use. Increased media attention on this issue has also contributed to increased
community concern. Opioid abuse is a priority to be addressed in the community due to rising use in Mat-Su,
along with the nature of the substance.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 37
Consumption
This section summarizes lifetime prescription drug misuse and current prescription drug misuse. In each
indicator, it presents data from middle school to high school if available. In the high school data, the data is
presented in the following order: all students, traditional high school students and alternative high school
students.
Lifetime Use of Prescription Drugs
Middle School
In 2015, 10.5 percent of Mat-Su middle school students reported had ever used prescription drugs without a
doctor’s prescription. This accounts for an estimated 226 students. In terms of trends in the Mat-Su, there were
no statistical differences in this rate of use between 2011 and 2015.
Figure 6. Lifetime Use of Prescription Drugs, Middle School Students, Mat-Su, Percent,
2011, 2013, and 2015
15.4
14.8
10.5
2011
2013
2015
Source: YRBS.
There were also no statistical differences between Mat-Su and Alaska middle school students between 2011
and 2015.
Figure 7. Lifetime Use of Prescription Drugs, Middle School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
Alaska
15.4
10.5
13.4
9.4
2011
2013
2015
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 38
In 2015, there were no statistical difference for gender, race/ethnicity, grade level, or age groups. Within MatSu middle school students in 2015, there were no statistical differences between males and females, races, grade
levels, or age groups.
Table 19. Lifetime Use of Prescription Drugs, Middle School Students, 2015
Percent
(%)
Statistical difference
between…?
Mat-Su 2015 and 2011
Middle School Students
10.5

Male
10.0
Female
11.5


2015
Demographics
Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic, Single Race Only)
11.4
Alaska Native
10.6


Grade Level
7th Grade
7.6
8th Grade
12.7


Age Groups
13 or Younger
7.6
14 and 15 Years of Age
15.6


Source: YRBS.
All High School
In 2015, 17.7 percent of all high school students in Mat-Su had ever taken prescription drugs without a
prescription from a doctor, representing an estimated 766 students. While the Mat-Su prevalence appears to
have decreased slightly, there is no statistically significant change between 2011 and 2015.
Figure 8. Lifetime Use of Prescription Drugs, All High School Students,
Mat-Su, Percent, 2011, 2013, and 2015
21.4
2011
17.6
17.7
2013
2015
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 39
Though the Mat-Su prevalence among all high school students appears higher than the state for all three survey
years, no statistically significant difference exists.
Figure 9. Lifetime Use of Prescription Drugs, All High School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
Alaska
21.4
17.7
14.6
15.8
2011
2013
2015
Source: YRBS.
Traditional High School
In 2015, 15.0 percent of Mat-Su traditional high school students reported ever having used prescription drugs
without a doctor’s prescription, accounting for an estimated 582 students. While the trend appears to decrease,
this prevalence rate did not change significantly during between the three survey years.
Figure 10. Lifetime Use of Prescription Drugs, Traditional High School Students,
Mat-Su, Percent, 2011, 2013, and 2015
18.2
2011
15.9
15.0
2013
2015
Source: YRBS.
When compared to Alaska and U.S. traditional high school students, prevalence rates for lifetime use of
prescription drugs do not differ statistically between Mat-Su, Alaska, and U.S. traditional students for all three
survey years.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 40
Figure 11. Lifetime Use of Prescription Drugs, Traditional High School Students,
Mat-Su, Alaska, and U.S., Percent, 2011, 2013, and 2015
Mat-Su
Alaska
U.S.
20.7
16.8
18.2
15.0
14.6
15.8
2011
2013
2015
Source: YRBS.
When assessing trends between 2011 and 2015, there were no statistical changes for Mat-Su traditional high
school students by gender, race/ethnicity, grade level, or academic grades.
While not included in the table, there were no statistical differences within the Mat-Su traditional high school
student population between males and females, races, grade levels, and academic grades in 2015.
However, Mat-Su traditional high school students reported lower percentages than Mat-Su alternative high
school students for all indicators. Mat-Su traditional high school students reported a lower percentage than
Mat-Su alternative high school students in overall prevalence (15.0 of traditional versus 39.4 percent of
alternative high school students), males (14.6 versus 37.6 percent), females (15.5 versus 41.4 percent), whites
(16.8 versus 38.7 percent), Alaska Natives (13.4 versus 37.5 percent), 11th graders (15.9 versus 47.9 percent), 12th
graders (17.9 versus 40.4 percent), students who receive mostly As and Bs academic grades (12.0 versus 36.4
percent), and students who receive mostly Cs, Ds, and Fs academic grades (21.7 versus 41.5 percent) (p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 41
Table 20. Lifetime Use of Prescription Drugs, Traditional High School Students, 2015
2015
Statistical difference between…?
Mat-Su and
Mat-Su and
Mat-Su Trad. and MatAlaska Trad.
U.S. Trad.
Su Alt. Students
Students
Students
Percent
(%)
Mat-Su 2015 and
2011 Trad.
Students
15.0




Male
14.6
Female
15.5














NA


NA
NA
NA












NA


NA
NA
NA
NA


Demographics
Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic,
Single Race Only)
16.8
Alaska Native
13.4
Other Races
10.4
Grade Level
9th Grade
11.4
10th Grade
16.1
11th Grade
15.9
12th Grade
17.9
NA


Academic Grades
Mostly As and Bs
12.0
Mostly Cs, Ds, Fs,
21.7
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Alternative High School
In 2015, 39.4 percent of Mat-Su alternative high school students reported ever having used prescription drugs,
representing an estimated 174 students. The trend has not changed statistically during the three years of data.
Figure 12. Lifetime Use of Prescription Drugs, Alternative High School Students,
Mat-Su, Percent, 2011, 2013, and 2015
45.1
2011
36.0
39.4
2013
2015
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 42
Among alternative high school students in Mat-Su and statewide, the prevalence rate for having ever used
prescription drugs without a prescription from a doctor did not differ statistically for all years reported.
Figure 13. Lifetime Use of Prescription Drugs, Alternative High School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
Alaska
45.1
39.4
41.3
2011
37.4
2013
2015
Source: YRBS
Generally, there were no changes in the trends between 2011 and 2015 for Mat-Su alternative high school
lifetime misuse of prescription drugs where data was available by demographic variables. Where data was
available in 2015, Mat-Su alternative high school students reported a higher percentage than Mat-Su traditional
high school students in overall prevalence (39.4 versus 15.0 percent), males (37.6 versus 14.6 percent), females
(41.4 versus 15.5 percent), whites (38.7 versus 16.8 percent), Alaska Natives (37.5 versus 13.4 percent), 11th
graders (47.9 versus 15.9 percent), 12th graders (40.4 versus 17.9 percent), students who receive mostly As and
Bs academic grades (36.4 versus 12.0 percent), and students who receive mostly Cs, Ds, and Fs academic grades
(41.5 versus 21.7 percent) (p<.05).
When comparing within demographic categories for Mat-Su alternative high school students in 2015, there are
no statistical differences between genders, race/ethnicities, grade levels, or academic grades.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 43
Table 21. Lifetime Use of Prescription Drugs, Alternative High School Students, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su 2015
Mat-Su and
Mat-Su Alt. and
and 2011 Alt.
Alaska Alt.
Mat-Su Trad.
Students
Students
Students
39.4



Male
37.6
Female
41.4






White (Non-Hispanic,
Single Race Only)
38.7

Alaska Native
37.5
NA




---
NA
NA
NA
9th Grade
---
NA
NA
NA
10th
---
NA
NA
NA
11th Grade
47.9

12th Grade
40.4
NA




Mostly As and Bs
36.4

NA
Mostly Cs, Ds, Fs,
41.5
NA
NA


Overall Prevalence
Gender
Race/Ethnicity
Other Races
Grade Level
Grade
Academic Grades
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Past 30 Days Use of Prescription Drugs
Middle School
In 2015, 6.0 percent of Mat-Su middle school students reported using prescription drugs without a doctor’s
prescription in the past 30 days, accounting for an estimated 129 students.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 44
Table 22. Current Use of Prescription Drugs, Middle School Students, 2015
Percent
(%)
6.0
Demographics
Overall Prevalence
Gender
Male
6.5
Female
4.9
Race/Ethnicity
White (Non-Hispanic, Single Race Only)
6.7
Alaska Native
6.6
Grade Level
7th Grade
3.4
8th
7.9
Grade
Age Groups
13 or Younger
3.9
14 and 15 Years of Age
9.6
Source: YRBS.
All High School
In 2015, 8.4 percent of all high school students in Mat-Su reported they used prescription drugs without a
prescription from a doctor within the past 30 days. This prevalence represents an estimated 363 Mat-Su
students. While this percentage appears to have dropped between 2011 and 2015, the change is not statistically
significant.
Figure 14. Current Use of Prescription Drugs, All High School Students,
Mat-Su, Percent, 2011, 2013, and 2015
11.5
2011
8.7
8.4
2013
2015
Source: YRBS.
In 2015 and 2013, the prevalence rates of current prescription opioid use without a prescription for all high
school students in Mat-Su and Alaska did not differ significantly from Alaska’s median prevalence. In 2011, the
prevalence rate in Mat-Su (11.5 percent) was higher than Alaska (6.9 percent) (p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 45
Figure 15. Current Use of Prescription Drugs, All High School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
Alaska
11.5
8.4
6.9
6.4
2011
2013
2015
Source: YRBS.
Traditional High School
In 2015, 6.9 percent of Mat-Su traditional high school students reported using prescription drugs without a
doctor’s prescription in the past 30 days, which represents an estimated 268 students. While this percentage
appears to have dropped between 2011 and 2015, the change is not statistically significant.
Figure 16. Current Use of Prescription Drugs, Traditional High School Students,
Mat-Su, Percent, 2011, 2013, and 2015
9.7
2011
7.6
6.9
2013
2015
Source: YRBS.
The prevalence rate did not differ significantly between Mat-Su and Alaska in any of the three survey years.
Figure 17. Current Use of Prescription Drugs, Traditional High School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
Alaska
9.7
6.9
6.9
6.4
2011
2013
2015
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 46
When assessing trends by demographics for current prescription drug misuse, there were no statistical
differences between 2011 and 2015 by gender, race/ethnicity, grade level, and academic grants. When
comparing Mat-Su traditional high school students with Alaska traditional high school students in 2015, there
were also no statistical differences by the same demographic variables.
When assessing differences within Mat-Su traditional high school students for current prescription drug misuse
in 2015, there were no statistical differences between genders, races/ethnicities, or grade levels. However, MatSu traditional high school students achieving mostly As and Bs academic grades in 2015 reported a statistically
lower percentage of current prescription drug use (4.5 percent) compared to traditional high school students
scoring mostly Cs, Ds, and Fs academic grades (12.2 percent) (p<.05).
In 2015, Mat-Su traditional high school students reported a lower percentage than Mat-Su alternative high
school students in overall prevalence of current prescription drug use (6.9 percent of traditional versus 20.1
percent of alternative high school students), males (6.2 versus 19.4 percent), females (7.7 versus 20.9 percent),
Whites (7.7 versus 18.1 percent), 11th graders (6.9 versus 21.5 percent), 12th graders (4.7 versus 21.6 percent),
and students who received mostly As and Bs academic grades (4.5 versus 16.2 percent) (p<.05).
Table 23. Current Prescription Drug Use, Traditional Students, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su 2015 and
Mat-Su and
Mat-Su Trad. and Mat2011 Trad.
Alaska Trad.
Su Alt. Students
Students
Students
6.9



Male
6.2
Female
7.7













NA
NA








NA


NA


Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic,
Single Race Only)
7.7
Alaska Native
5.8
Other Races
5.2
Grade Level
9th Grade
7.5
10th Grade
7.8
11th Grade
6.9
12th Grade
4.7
NA


Academic Grades
Mostly As and Bs
4.5
Mostly Cs, Ds, Fs,
12.2
NA
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 47
Alternative High School
In 2015, 20.1 percent of Mat-Su alternative high school students reported using prescription drugs without a
doctor’s prescription in the past 30 days, accounting for an estimated 89 students. The Mat-Su rate did not
change significantly throughout the three survey years.
Figure 18. Current Use of Prescription Drugs, Alternative High School Students,
Mat-Su, 2011, 2013, and 2015
26.7
21.4
2011
2013
20.1
2015
Source: YRBS.
Compared with statewide, the Mat-Su prevalence rate for current prescription drug use was higher in 2011
(p<.05), though it did not statistically differ in 2013 and 2015.
Figure 19. Current Use of Prescription Drugs, Alternative High School Students,
Mat-Su and Alaska, 2011, 2013, and 2015
Mat-Su
Alaska
26.7
20.1
21.6
2011
19.8
2013
2015
Source: YRBS.
Prevalence among Mat-Su alternative high school students who reported current prescription drug misuse and
received mostly As and Bs decreased from 2011 to 2015, from 30.8 to 16.2 percent (p<.05).
Within Mat-Su alternative high school students who currently misuse prescription drugs in 2015, there were no
statistical differences between genders, race/ethnicities, grade levels, or academic grades.
Mat-Su alternative high school students reported a higher percentage of current prescription drug misuse than
Mat-Su traditional high school students in overall prevalence (20.1 versus 6.9 percent), males (19.4 versus 6.2
percent), females (20.9 versus 7.7 percent), Whites (18.1 versus 7.7 percent), 11th graders (21.5 versus 6.9
percent), 12th graders (21.6 versus 4.7 percent), and students who received mostly As and Bs (16.2 versus 4.5
percent) (p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 48
Table 24. Current Use of Prescription Drugs, Alternative Students, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su 2015
Mat-Su and
Mat-Su Alt. and
and 2011 Alt.
Alaska Alt.
Mat-Su Trad.
Students
Students
Students
20.1



Male
19.4
Female
20.9






White (Non-Hispanic,
Single Race Only)
18.1

Alaska Native
16.1
NA




-
NA
NA
NA
9th Grade
-
NA
NA
NA
10th
-
NA
NA
NA
11th Grade
21.5

12th Grade
21.6
NA




Mostly As and Bs
16.2
NA
Mostly Cs, Ds, Fs,
23.8




Overall Prevalence
Gender
Race/Ethnicity
Other Races
Grade Level
Grade
Academic Grades
NA
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 49
Consequences
This chapter presents available data on consequences of prescription opioid misuse. It presents opioid
poisoning to the National Poison Control Data Systems, emergency department discharges, the prevalence of
dependence or abuse from prescription opioids. It concludes with available arrest data.
Poisoning
According to the National Poison Data System, which relies on poison control call centers and medical records,
there were 3 poisonings by opiates occurred among Mat-Su residents between age 12-25 at a rate of 1.5
poisonings per 10,000 persons in 2015. Statewide in 2015, opiate poisonings occurred at a rate of 1.2 poisonings
per 10,000 persons.
Figure 20. Rate of Opiate Poisonings Per 10,000 Persons Age 12-25,
Mat-Su and Alaska, Percent, 2012-2015
Mat-Su
Alaska
3
2
1.5
0.5
1
1.2
0.5
0
2012
2013
2014
2015
Source: National Poisoning Data System.
Table 25. Number and Rate of Opiate Poisonings, Mat-Su, 2012-2015
Year
# of Poisonings
2012
1
Mat-Su
Rate of Poisonings Per
10,000 Persons Aged 12-25
0.5
2013
4
2.0
27
1.6
2014
3
1.5
32
2.0
2015
3
1.5
19
1.2
# of Poisonings
8
Alaska
Rate of Poisonings Per
10,000 Persons Aged 12-25
0.5
Source: National Poisoning Data System.
ED Discharges
In 2015, 159 discharges from the Mat-Su ED were related to opioids, 19 of which were poisonings. They occurred
at a rate of 5.4 per 1,000 discharges. Statewide, opioid-related discharges occurred at a rate of 4.9 per 1,000
discharges.
Females and Mat-Su residents ages 12-25 accounted for a disproportionately large share of opioid-related
discharges relative to their share of the population. Females make up 48.2 percent of Mat-Su’s population yet
accounted for 54.7 percent of opioid-related discharges. Mat-Su residents ages 12-25 make up 23.0 percent of
the population and accounted for 32.1 percent of opioid-related discharges. Statewide, females also accounted
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 50
for a disproportionately large share of opioid-related discharges. For age, statewide figures followed an
opposite trend: individuals ages 12-25 accounted for a disproportionately small share of opioid-related
discharges relative to their share of the population.
Table 26. Number of Opioid-Related ED Discharges and Rate per 1,000 ED Discharges,
Ages 12+, Mat-Su and Alaska, 2015
Mat-Su
Alaska
29,682
279,971
Opioid-related discharges
159
1,380
Rate of opioid-related discharges per 1,000 discharges
5.4
4.9
All ED discharges
Source: HFDR.
Table 27. Number of Prescription Opioid-Related Emergency Department Discharges
and Percent of Population, Ages 12+, Mat-Su and Alaska, 2015
#
Mat-Su
% of
Population
Age 12+
% of
Total
Population
Age 12+
#
% of
Total
Alaska
% of
Population
Age 12+
Population
Age 12+
Prescription Opioid-Related Discharges
Type
Poisoning
13
8.2
–
–
62
4.5
–
–
Other
146
91.8
–
–
1,318
95.5
–
–
Male
72
45.3
51.8
42,043
634
45.9
51.9
326,995
Female
87
54.7
48.2
39,176
746
54.1
48.1
303,412
12-25
51
32.1
23.0
18,661
296
21.4
25.9
163,553
26+
108
67.9
77.0
62,557
1,084
78.6
74.1
466,854
Total
159
81,219
1,380
Gender
Age
630,407
Prescription Opioid Poisoning Discharges
Gender
Male
6
46.2
51.8
42,043
22
35.5
51.9
326,995
Female
7
53.8
48.2
39,176
40
64.5
48.1
303,412
81,219
62
Total
13
630,407
Source: HFDR, DOLWD.
Dependence or Abuse
Between 2002 and 2011, there were an estimated 387 Mat-Su residents dependent on pain relievers, and 193
that abused.
Table 28. Mat-Su Pain Reliever Non-Medical Dependence. 2002-2011
Mat-Su
Prevalence
Estimated
Number of MatSu Residents
Past year pain reliever dependence
0.6
387
Past year pain reliever abuse
0.3
193
Description
Difference Between
Mat-Su and Alaska
Difference Between
Mat-Su and U.S.




Source: NSDUH.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 51
Deaths
Between the years 2009 and 2013, opiates caused 63 deaths in Mat-Su for residents of all ages at an average of
16 deaths per year. Prescription opioids accounted for 56 of the total deaths and an annual average of 14 deaths
per year.
Table 29. Number of Prescription Opioid Deaths, Other Opioid Deaths,
and Total Opioid Deaths, Mat-Su, 2009-2013
# of Deaths
(2009-2013)
56
Annual
Average
11
Other opioid deaths
7
1
.03
Total opioid deaths
63
13
.28
Prescription opioid deaths
Rate per 10,000 Population
.25
Source: CDC WONDER.
Arrests
In 2015, Mat-Su law enforcement made 70 opioid-related arrests. Arrests for possession (misconduct involving
a controlled substance in the 4th degree) comprised the majority (39) of these arrests. Arrests for manufacturing,
delivery, or intent to distribute (misconduct involving a controlled substance in the 2nd degree) accounted for
almost half of all opioid-related arrests.
Table 30. Number of Arrests for Misconduct Involving
Schedule IA Controlled Substances, Mat-Su, 2015
Violation
Number of Arrests
Misconduct involving a controlled substance in the 1st degree
Misconduct involving a controlled substance in the
2nd
degree
Misconduct involving a controlled substance in the
3rd
1
29
degree
1
Misconduct involving a controlled substance in the 4th degree
39
Total Arrests
70
Source: THRIVE Mat-Su.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 52
Risk and Protective Factors
This chapter presents available data on risk and protective factors associated with prescription opioid misuse. It
presents a range of indicators including risk of harm, parental and friends’ views of prescription opioid misuse,
retail availability, drug take back total pounds, community messaging, provider discussions, and perceptions of
it as a community harm.
Risk of Harm from Prescription Drug use as Moderate or Greater
Middle School
In 2015, 75.4 percent of Mat-Su middle school students reported they believed the risk of harm from misusing
prescription drugs was moderate or greater. This accounts for an estimated 1,626 students. Within Mat-Su
middle school students in 2015, there were no statistical difference between genders, race/ethnicities, grade
levels, or age groups.
Table 31. Risk of Harm Moderate or Greater, Middle School Students, Mat-Su, 2015
Demographics
Overall Prevalence
Percent
(%)
75.4
Gender
Male
73.7
Female
79.2
Race/Ethnicity
White (Non-Hispanic, Single Race Only)
75.2
Alaska Native
72.7
Grade Level
7th Grade
74.7
8th
75.9
Grade
Age Groups
13 or Younger
76.3
14 and 15 Years of Age
73.7
Source: YRBS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 53
Traditional High School
In 2015, 83.9 percent of Mat-Su traditional high school students reported they believe there is a moderate or
great risk of harm from misusing prescription drugs, accounting for 3,257 students. Mat-Su traditional high
school students reported a higher percentage than Mat-Su alternative high school students in overall
prevalence (83.9 versus 73.8 percent), females (88.9 versus 73.7 percent), whites (84.2 versus 74.3 percent), and
12th graders (86.3 versus 71.7 percent) (p<.05).
Table 32. Risk of Harm from Prescription Drug Use as Moderate or Greater,
Traditional High School Students, Mat-Su, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su and
Mat-Su Trad. and MatAlaska Trad.
Su Alt. Students
Students
83.9


Male
79.8
Female
88.9






Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic,
Single Race Only)
84.2
Alaska Native
83.5


Other Races
83.4
NA
NA
9th Grade
85.1
NA
10th Grade
83.5
11th Grade
81.1
12th Grade
86.3




Mostly As and Bs
85.9
NA
Mostly Cs, Ds, Fs,
79.8
NA


Grade Level
NA


Academic Grades
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Alternative High School
In 2015, 73.8 percent of Mat-Su alternative high school students reported they believe there is a moderate or
great risk of harm if misusing prescription drugs, accounting for 326 students. Mat-Su alternative high school
students reported a lower percentage than Mat-Su traditional high school students in overall prevalence (73.8
versus 73.8 percent), females (73.7 versus 88.9 percent), whites (74.3 versus 84.2 percent), and 12th graders (71.7
versus 71.7 percent) (p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 54
Table 33. Risk of Harm from Prescription Drug Use as Moderate or Greater,
Alternative High School Students, Mat-Su, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su and
Mat-Su Alt. and
Alaska Alt.
Mat-Su Trad.
Students
Students
73.8


Male
73.8
Female
73.7






Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic,
Single Race Only)
74.3
Alaska Native
80.1


-
NA
NA
9th Grade
-
NA
NA
10th Grade
-
NA
NA
11th Grade
75.5
12th Grade
71.7




Mostly As and Bs
72.6
NA
Mostly Cs, Ds, Fs,
73.6
NA


Other Races
Grade Level
Academic Grades
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Parents View Prescription Drug Use as Wrong or Very Wrong
Middle School
In 2015, 87.6 percent of Mat-Su middle school students reported they believed their parents perceived
prescription drug misuse as wrong or very wrong. This accounts for an estimated 1,890 students.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 55
Table 34. Parents View Prescription Drug Use as Wrong or Very Wrong,
Middle School Students, Mat-Su, 2015
Demographics
Overall Prevalence
Percent
(%)
87.6
Gender
Male
87.0
Female
89.1
Race/Ethnicity
White (Non-Hispanic, Single Race Only)
88.9
Alaska Native
85.7
Grade Level
7th Grade
90.8
8th Grade
85.3
Age Group
13 or Younger
90.1
14 and 15 Years of Age
83.4
Source: YRBS.
Traditional High School
In 2015, 92.6 percent of Mat-Su traditional high school students reported their parents view prescription drug
misuse as wrong or very wrong, accounting for 3,595 students. Mat-Su traditional high school students reported
a higher percentage than Mat-Su alternative high school students in overall prevalence (92.6 versus 86.2
percent), females (91.8 versus 84.3 percent), and students that received mostly As and Bs (93.6 versus 85.0
percent) (p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 56
Table 35. Parents View Prescription Drug Use as Wrong or Very Wrong,
Traditional High School Students, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su and
Mat-Su Trad. and MatAlaska Trad.
Su Alt. Students
Students
92.6


Male
93.2

Female
91.8



White (Non-Hispanic,
Single Race Only)
92.6

Alaska Native
90.2



Other Races
94.7
NA
NA
9th Grade
93.0
NA
10th Grade
92.0


11th Grade
93.2

12th Grade
91.9



Mostly As and Bs
93.6
NA
Mostly Cs, Ds, Fs,
89.9
NA
Overall Prevalence
Gender
Race/Ethnicity
Grade Level
NA
Academic Grades


Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Alternative High School
In 2015, 86.2 percent of Mat-Su alternative high school students reported their parents view prescription drug
misuse as wrong or very wrong, accounting for 381 students. Mat-Su alternative high school students reported
a lower percentage than Mat-Su traditional high school students in overall prevalence (86.2 versus 92.6 percent),
females (84.3 versus 91.8 percent), and students that received mostly As and Bs (85.0 versus 93.6 percent)
(p<.05).
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 57
Table 36. Parents View Prescription Drug Use as Wrong or Very Wrong,
Alternative High School Students, Mat-Su, 2015
2015
Demographics
Percent
(%)
Statistical difference between…?
Mat-Su and
Mat-Su Alt. and
Alaska Alt.
Mat-Su Trad.
Students
Students
86.2


Male
87.9
Female
84.3






Overall Prevalence
Gender
Race/Ethnicity
White (Non-Hispanic,
Single Race Only)
86.2
Alaska Native
85.9


-
NA
NA
9th Grade
-
NA
NA
10th Grade
-
NA
NA
11th Grade
89.9
12th Grade
84.1




Mostly As and Bs
85.0
NA
Mostly Cs, Ds, Fs,
86.8
NA


Other Races
Grade Level
Academic Grades
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Friends Consider It Wrong or Very Wrong
In 2015, 73.1 percent of Mat-Su middle school students reported they believed their friends thought misusing
prescription drugs was wrong or very wrong. This accounts for an estimated 1,576 students.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 58
Table 37. Friends Consider Wrong or Very Wrong, Middle School Students, Mat-Su, 2015
Percent
(%)
73.1
Demographics
Overall Prevalence
Gender
Male
73.0
Female
73.1
Race/Ethnicity
White (Non-Hispanic, Single Race Only)
73.6
Alaska Native
76.4
Grade Level
7th Grade
76.2
8th
70.7
Grade
Age Group
13 or Younger
75.7
14 and 15 Years of Age
68.4
Source: YRBS.
Retail Availability of Prescription Opioids
In 2015, half of the 143 Mat-Su young adults (ages 18-25) surveyed by YASUS had ever been prescribed opioids.
Half of young adults in Alaska also had used prescribed opioids ever.
Table 38. Number and Percent of Young Adults Who Have Ever Been Prescribed Opioids,
Mat-Su and Alaska, 2015
Mat-Su
Percent
Number
(%)
Question
Alaska
Percent
Number
(%)
Have you ever been prescribed opioids?
No, never
74
51.7
389
49.9
Yes, more than 3 years ago
28
19.6
180
23.1
Yes, within the last 3 years
41
28.7
210
27.0
No response
Total Respondents
0
0.0
0
0.0
143
100.0
779
100.0
Source: YASUS.
Drug Take Back
The Mat-Su Borough hosts drug take-back events twice a year to allow for safe disposal of unused, unwanted,
or expired medications. Collection occurs at three locations: Fred Meyers (Palmer and Wasilla) and Talkeetna
Sunshine Clinic. In 2016, the Mat-Su Borough collected 1,119 pounds of drugs. During the six years between
2011 and 2016, the Borough collected 4,295 pounds of drugs.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 59
Table 39. Reported Pounds Collected During Drug Take Back Events,
Various Mat-Su Communities
Year
Palmer
Wasilla
Talkeetna
Mat-Su Total
2011
120
267
95
482
2012
105.2
183
148
436.2
2013
322.5**
380.5**
470
1,173
2014
91.7
179.8
58.9
330.4
2015
377**
377**
–
754
2016
321
762
36
1,119
*No data recorded for the second half of 2014 for any Mat-Su location.
**Sometimes, Palmer and Wasilla reported jointly. It is estimated these reported totals
were split evenly between Palmer and Wasilla.
Source: Mat-Su Borough Drug Take-Back Program.
Community Messaging about Prescription Opioids
In Mat-Su, 40 percent of young adults surveyed by YASUS had never seen community messaging about
prescription opioids, compared to 50 percent of young adults throughout the entire state.
Figure 21. Community Messaging About Prescription Opioids Seen by Young Adults,
Mat-Su and Alaska, Percent, 2015
Mat-Su
Alaska
40.6
I have not seen any messages about prescription opioids
Safe use of prescription opioids as prescribed by a doctor
31.5
The safe disposal of leftover prescription opioids
22.7
29.4
21.3
17.5
18.0
The safe and secure storage of prescription opioids
No response
37.1
26.6
The risks of sharing prescription opioids with others
Another type of message about prescription opioids
49.3
2.1
2.1
0.7
0.5
Source: YASUS.
Provider Discussions with Young Adults about Prescribed Opioids
Compared to young adults statewide, young adults in Mat-Su who responded to YASUS and had been
prescribed opioids within the past three years experienced fewer conversations with providers or pharmacists
about their appropriate use. Less than 20 percent had a discussion with a provider or pharmacist about
treatment alternatives to prescription opioids. The most common conversation with providers, which about 50
percent of Mat-Su survey respondents experienced, addressed the potential side effects or problems from
prescription opioids.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 60
Figure 22. Discussions of Appropriate Opioid Use Between Providers/Pharmacists and Young Adults
Prescribed Opioids Within Past Three Years, Mat-Su and Alaska, Percent, 2015
Mat-Su
Alaska
53.7
59.5
Side effects or problems from use
41.5
Using pills as prescribed and not more
To not share pills with others
Expected benefits
22.0
25.7
Safe and secure storage of pills
19.5
21
Alternatives to prescription opioids
19.5
12.4
12.2
21.4
I do not remember
Specific treatment goals that included a plan for
stopping use
12.2
17.1
Risk of developing an opioid use disorder or addiction
No response
56.7
31.7
32.4
29.3
28.6
4.9
4.3
Source: YASUS.
Unused Prescription Drugs Disposal
Among Mat-Su young adults surveyed by YASUS who were prescribed opioids within the past three years and
had leftover, unused prescription opioids, more than half still have them in their possession.
Figure 23. Disposal of Leftover, Unused Prescription Opioids Among Young Adults
Prescribed Opioids Within Past Three Years, Mat-Su and Alaska, Percent, 2015
Mat-Su
Alaska
I still have them
22.0
26.7
I have never had any leftover
I flushed them down the toilet or sink
I gave them to a family member or friend for free
I threw them in the trash
I disposed of them at a drug "take back" program
I sold them to a family member or friend
I sold them on the street
I brought them to a pharmacy
Other
No response
56.1
52.4
9.8
10.0
7.3
5.7
4.9
6.2
4.9
5.2
0.0
0.0
0.0
0.0
0.0
1.4
0.0
0.5
0.0
0.5
Source: YASUS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 61
Community Problem
On a scale between 1 and 6, with 1 “not a problem at all” and 6 “a very large problem,” 42.7 percent of Mat-Su
young adults you participated in YASUS rate prescription opioid misuse in their community as a 5 or 6. This
compares with 37.3 percent among statewide young adults who participated in YASUS.
Figure 24. Perception of Prescription Opioid Misuse as a Community Problem, Mat-Su and Alaska,
Percent, 2015
Mat-Su
Alaska
6 A very large problem
18.2
17.5
5
16.1
4
2
9.8
11.0
1 Not a problem at all
11.2
11.2
19.4
20.3
20.7
3
No response
24.5
19.8
0.0
0.5
Source: YASUS.
Risk of Harm for Trying Prescription Opioids
YASUS asked survey respondents to rate the risk of harm when people try prescription opioid misuse once or
twice on a scale between 1 and 6, with 1 “no risk” and 6 “great risk.” About 55 percent of young adult
respondents in both Mat-Su and all Alaska rated trying prescription opioid misuse as a 5 or 6.
Table 40. Risk of Harm When People Try Misusing Prescription Opioids, Mat-Su and Alaska, 2015
Question
Mat-Su
Alaska
How much do people risk harming themselves physically or in other ways when they try
misusing prescription opioids (using without a prescription or in other ways other than as
prescribed) once or twice?
Response
Number
Percent
Number
Percent
1 No risk
5
3.5
40
5.1
2
9
6.3
76
9.8
3
23
16.1
119
15.3
4
26
18.2
118
15.1
5
24
16.8
164
21.1
6 Great risk
55
38.5
259
33.2
No response
Total respondents
1
0.7
3
0.4
143
100.0
779
100.0
Source: YASUS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 62
Risk of Harm for Regularly Misusing Prescription Opioids
YASUS asked survey respondents to rate the risk of harm when people regularly misuse prescription opioids
once or twice a week on a scale between 1 and 6, with 1 “no risk” and 6 “great risk.” Both in Mat-Su and
statewide, close to 80 percent of young adult respondents rated the risk as a 5 or 6.
Table 41. Risk of Harm When People Regularly Misuse Prescription Opioids, Mat-Su and Alaska, 2015
Question
Mat-Su
Alaska
How much do people risk harming themselves physically or in other ways when they regularly
misuse prescription opioids (using without a prescription or in other ways other than as
prescribed) once or twice per week?
Response
Number
Percent
Number
Percent
1 No risk
2
1.4
29
3.7
2
6
4.2
23
3.0
3
8
5.6
49
6.3
4
14
9.8
67
8.6
5
24
16.8
145
18.6
6 Great risk
88
61.5
462
59.3
No response
1
0.7
4
0.5
143
100.0
779
100.0
Total respondents
Source: YASUS.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 63
Community Factors
The State of Alaska selected social availability of prescription opioids, retail availability of prescription opioids,
and perceived risk for harm of non-medical use of prescription opioids as key intervening variables that affect
non-medical use of the drugs. Because intervening variables are broad concepts that manifest differently in
different communities, 64 identification of local, community factors that affect how the intervening variables
emerge in each region is a crucial component of the assessment phase. Understanding the local context sets
the foundation for an effective logic model and ultimately the selection of strategies that precisely target
regional issues.
To that end, THRIVE Mat-Su engaged in a facilitated session to identify and prioritize community factors that
impact social availability of prescription opioids, retail availability, and perceived risk for harm of non-medical
use of prescription opioids. This section summarizes the results by each topic area.
Social Availability of Prescription Opioids
Coalition members identified the following community factors related to the social availability of prescription
opioids. The list below reflects group-identified themes with associated sub-points in order of member
prioritization.
•
•
•
Lack of safe and positive support and supervision
o
Lack of awareness of risk
o
Peer pressure
o
Adults approaching teens to be dealers and adults marketing to youth
o
Lack of education in schools
o
Parents commute to Anchorage or North Slope, leaving kids unattended
Focus on pain management: “pain” = 5th vital sign
o
Doctors overprescribe due to lack of education or personal bias
o
Lack of knowledge/acceptance of alternative pain management
o
Incentives from Pharma
Geographical factors
o
Small rural communities sharing resources and knowing which neighbors have drugs
o
Lack of medical facilities and transportation barriers
o
Lack of law enforcement = no fear of use
•
Lack of disposal knowledge and disposal sites
•
Family and friends who are addicted or use prescription opioids in the home increase access
DHSS. (2016). Prevention of non-medical use of prescription opioids
http://www.iser.uaa.alaska.edu/Projects/pfs/docs/ PFSGuidanceDocument.pdf.
64
Community Needs Assessment
Prescription Opioid Misuse
and
heroin
use
in
Alaska.
Available
at:
McDowell Group, Inc.  Page 64
Figure 25. Community Factors that Impact the Social Availability of Prescription Opioids
Source: McDowell Group.
Retail Availability of Prescription Opioids
Coalition members identified the following community factors related to the retail availability of prescription
opioids. The list below reflects group-identified themes with associated sub-points in order of member
prioritization.
•
Overprescribing
o
Doctors are incentivized to prescribe, including marketing from pharma
o
Doctors lack knowledge of how to treat pain and are unaware of options other than
prescription drugs
•
o
Dental providers over-prescribing
o
Lack of education on alternative pain management strategies
o
Lots of prescribing for chronic pain
o
Pain clinics over-prescribing
Medication assisted treatment (MAT) is providing drugs rather than treatment
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 65
•
o
Complete avoidance of the negative impacts from suboxone
o
Prescribed suboxone is sold to others
o
Most common drug in Department of Corrections is suboxone
Pain is the 5th vital sign: pain management vs pain free
o
People have philosophy of stopping all pain rather than managing pain
•
Lack of education regarding addiction by people and providers
•
Lack of prescription drug monitoring
o
Prescription Drug Monitoring Program is voluntary
•
Lack of prescription drug disposal sites
•
Online purchasing (fentanyl)
Figure 26. Community Factors that Impact the Retail Availability of Prescription Opioids
Source: McDowell Group.
Perceived Risk of Prescription Opioids
Coalition members identified the following community factors related to the perceived risk of prescription
opioid misuse. The list below reflects group identified themes with associated sub-points in order of member
prioritization.
•
“Specific” risk education by primary providers and pharmacies
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 66
o
Unrealized risk of addiction to prescription drugs
o
“If it is a prescription, it is safe”
o
Low risk perception among youth
o
“Everyone” uses pain pill after tooth extraction
o
Kids do not have the maturity/brain development to understand the consequences:
“Invincible at 18”
•
Community and family norms
o
Parents and grandparents use and abuse prescription opioids, so perception is that they
are not harmful
•
o
Some elders don’t perceive drugs as harmful
o
Adults are stuck in their mindset that drugs aren’t harmful
o
“Normal teenage experimentation”
o
Not embracing traditional/eastern ways of healing or pain management
o
Availability of opioid medication normalized the use of opioids: Opioids in medicine cabinet
o
Stigma stops conversation
Lack of broad education through schools and media
o
Lack of information
o
Local newspaper has many stories on opioid abuse, awareness level of population is high
o
Not talking about it because of stigma
o
Less awareness than heroin, but due to recent publicity, awareness is increasing
o
Lack of info and education about dangers of opioids
Figure 27. Community Factors that Impact the Perceived Risk of PO
Source: McDowell Group.
Community Needs Assessment
Prescription Opioid Misuse
McDowell Group, Inc.  Page 67
Heroin
Literature Review
Use Patterns
The significant increase in prevalence of heroin use and abuse over the past decade has been driven primarily
by the increase in heroin use among young adults ages 18 to 25. 65 In 2013, young adults had the highest
prevalence rate of past year heroin use at 7.0 per 1000, compared to adolescents (ages 12 to 17) at 1.0 per 1000,
and older adults (over 26 years of age) at 2.0 per 1000. 66 In a study of a nationally-representative sample of
young adults, researchers found that lifetime, past-year, and past-month prevalence rates of heroin use were
18.4, 7.3 and 3.3 per 1000 for those same age groups, respectively. 67
Young adults, on average, initiate heroin use between ages 18 and 19. 68 Most young adults are non-injection
heroin users, and the most common route of use is sniffing. 69 Early initiation of non-medical use of prescription
opioids is a known risk factor for heroin use. 70 While most research to date has focused on heroin use in the
general population, evidence does suggest that heroin use patterns among non-medical prescription opioid
users are different. 71
GENDER
Male young adults have reported significantly higher rates of lifetime, past-year, and past-month heroin use
than have females of the same age. 72
RACE/ETHNICITY
Non-Hispanic, white young adults report statistically significant higher prevalence rates of lifetime, past year
and past month heroin use compared to non-Hispanic Black, Hispanic, and other non-Hispanic young adults. 73
GEOGRAPHY
No significant variation in heroin use has been found in young adults living in large, small, or non-urban areas. 74
65
Ihongbe, T. O., & Masho, S. W. (2016). Prevalence, correlates and patterns of heroin use among young adults in the United States. Addictive
Behaviors, 63, 74-81.
Ibid.
Ibid.
Ibid.
69
Ibid.
70 Martins, S. S., Segura, L. E., Santaella-Tenorio, J., Perlmutter, A., Fenton, M. C., Cerdá, M., ... & Hasin, D. S. (2017). Prescription opioid use
disorder and heroin use among 12-34-year-olds in the United States from 2002 to 2014. Addictive Behaviors, 65, 236-241.
71
Ihongbe, T. O., & Masho, S. W. (2016). Prevalence, correlates and patterns of heroin use among young adults in the United States. Addictive
Behaviors, 63, 74-81.
66
67
68
72
Ihongbe, T. O., & Masho, S. W. (2016). Prevalence, correlates and patterns of heroin use among young adults in the United States. Addictive
Behaviors, 63, 74-81.
73
74
Ibid.
Ibid.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 69
MENTAL HEALTH
Young adults who have experienced depressive episodes have been found to use heroin at higher rates. 75
OTHER
Unemployed young adults, as well as widowed, divorced, or separated young adults display statistically
significant higher prevalence rates of lifetime, past-year, and past-month heroin use.
Perception of Risk for Harm
Perception of risk for harm refers to the degree to which an individual identifies heroin use as potentially
dangerous. As described in the prescription opioid section, young-adult, non-dependent drug users draw upon
several pieces of information when assessing the risk of drugs and the degree to which those risks can be
managed including: potential for addiction, overdose or death; organ damage; uncontrollable highs; harm to
the brain; as well as other factors like routes of administration, acceptability of use, and personal vulnerability. 76
Heroin is assessed as extremely addictive and as carrying a high risk of overdose and death. 77 In general, young
adults perceive heroin, crack, and methamphetamine as the most risky and harmful drugs. 78 Within the general
population, non-medical users of prescription opioids who have tried heroin perceive heroin as less risky,
compared to those who have not tried heroin. 79 This signals the important role of non-medical use of
prescription opioids in moderating assessment of risk of heroin. In contrast, female prescription opioid users,
those who initiated non-medical use of prescription opioids at a later age, and individuals who use marijuana
perceive heroin as more risky than other types of initial drug user i.e. persons who use marijuana initially perceive
heroin as riskier than those who initiated other types of drugs.
According to results from the NSDUH, most people 12 years of age and older think trying heroin, whether once
or twice or on a weekly basis, carries a great risk. 80 Perception of risk from heroin use increases with age among
adolescents, such that a higher percentage of adolescents ages 16-17 perceive great risk from heroin use than
adolescents ages 14-15 and a higher percentage of adolescents ages 14-15 perceive great risk from heroin use
than 12-13-year-olds. 81
Social Availability
Limited academic research describes the social availability of heroin. Prevalence rates suggest that heroin is
widely available, though precise pathways individuals use to obtain heroin are less clearly defined. Research
does describe that availability of heroin, unlike availability of prescription opioids, is a result of international
75
Ihongbe, T. O., & Masho, S. W. (2016). Prevalence, correlates and patterns of heroin use among young adults in the United States. Addictive
Behaviors, 63, 74-81.
76 Daniulaityte, R., Falck, R., & Carlson, R. G. (2012). “I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk
among illicit users of pharmaceutical opioids. International Journal of Drug Policy, 23(5), 374-384.
77
Ibid.
78
Ibid.
79
Votaw, V. R., Wittenauer, J., Connery, H. S., Weiss, R. D., & McHugh, R. K. (2017). Perceived risk of heroin use among nonmedical
prescription opioid users. Addictive Behaviors, 65, 218-223.
80 Lipari, R. & Hughes, M.S. (2015). Trends in heroin use in the united states: 2002 to 2013. SAMHSA. Available at:
https://www.samhsa.gov/data/sites/default/ files/report_1943/ShortReport-1943.html.
81
Ibid.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 70
trafficking of heroin. In the United States, most heroin comes from Columbia and Mexico; purity and type of
heroin, and therefore risk, vary based on origin. 82 Some research suggests that different types of heroin
markets—from open markets with unrestricted access to more closed markets controlled by private dealers—
exist geographically. 83 Individuals also obtain heroin through different types of engagement with dealers,
including face-to-face deals, brokering or “copping,” and a secondary dealer or “juggling” 84
82
Ciccarone, D. (2009). Heroin in brown, black and white: Structural factors and medical consequences in the US heroin market. International
Journal of Drug Policy, 20(3), 277-282.
83 Mars, S. G., Fessel, J. N., Bourgois, P., Montero, F., Karandinos, G., & Ciccarone, D. (2015). Heroin-related overdose: The unexplored
influences of markets, marketing and source-types in the United States. Social Science & Medicine, 140, 44-53.
84 Hoffer, L., & Alam, S. J. (2013, April). “Copping” in Heroin Markets: The Hidden Information Costs of Indirect Sales and Why They Matter.
In International Conference on Social Computing, Behavioral-Cultural Modeling, and Prediction (pp. 83-92). Springer Berlin Heidelberg.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 71
Community Readiness Results
This section summarizes results specific to heroin from the Community Readiness Survey, including scoring and
key themes that emerged from open-ended responses.
Community Readiness Score
In assessing readiness of the Mat-Su community on heroin, scores include an average of 2.80 on community
knowledge of efforts, 3.38 on leadership, 3.55 on community climate of the issue, 3.05 on community knowledge
of the issue, and 3.00 on resources knowledge.
Table 42. Heroin Community Readiness Scoring Results
Domain
Average
Common Themes Identified in Scoring Process
Community
Knowledge of Efforts
2.80
Awareness comes from media, personal connections to the drug, and more
effects such as needles found around the community
Leadership
3.38
Respondents support change, but it does not seem to be a top priority in
the community and therefore not one of their priorities either
Community Climate
3.55
They see the effects (needles and media coverage) but only seem to want
change when it is personal
Community
Knowledge of Issue
3.05
No knowledge about local services, effects, resources, think that it is not
their problem unless its personal
Resources
3.00
They think they are out there, but are unaware of process or how to get into
contact with those unless personally affected
Community Readiness Responses Themes
In the Community Readiness Survey, many open-ended responses support an assessment. This section
summarizes the themes that emerged from respondents.
Overall Summary
Strong concern in the Mat-Su about heroin has resulted from increases in crime, overdoses, and fatalities along
with accompanying media attention. Additionally, use is widespread among all ages and backgrounds, and,
therefore, impacts are widespread effect on others. Also, evidence of use is more visible on the streets. Due to
this strong concern about this highly addictive and deadly substance, addressing heroin in the community is a
priority. The priority includes reducing crime rates and increasing community member sense of safety. Also,
education is key about the dangers of heroin and the broad impact on the community.
MISCONCEPTIONS
Misconceptions among community members about heroin use include how easy it is to get addicted and how
hard it is to detox and get off the drug. The link between pain, trauma, mental health, pain medication, and the
magnitude and scope of the problem is often not recognized, partly because use of the drug is often stigmatized
as a character flaw or a low-income, uneducated, and homeless problem. Signs and symptoms of use, as well
as the link between use and Adverse Childhood Experiences are also not understood.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 72
ACCESS
Heroin is currently accessed not only through dealers and theft, but also through family, friends, schools, work
places, other social outlets. Prevention of access includes education about signs and symptoms of use and help
through law enforcement activity.
COMMUNITY STRENGTHS
Strengths of current prevention and intervention strategies include education and outreach efforts and
community concern. The Mat-Su Opioid Task Force efforts on harm reduction are recognized. The opiate
treatment program at the community health center is also recognized as providing a model for integrated
medical and behavioral health treatment for opiate addiction.
COMMUNITY CHALLENGES
Weaknesses in heroin prevention and intervention strategies in the Mat-Su include need for more cooperation
between treatment providers, capacity (OBOT can only serve a certain number of people for example), and need
for rehabilitation housing. Community perceptions and controversy over location of treatment centers and
transitional housing also presents a weakness. Another noted issue is that drugs are acquired in jail, and jails
are resistant to using Vivitrol. Underserved populations include youth, the middle and upper class, and outlying
areas in the borough.
INTERVENTION EFFORTS CRITICAL TO PREVENTION
Plans for further prevention and intervention efforts include further work with law enforcement, on issues such
as Narcan, and with the drug court. More alternatives, such as clinics that prescribe suboxone and other drugs,
as well as faith-based centers, are needed, as well as addiction specialists and counselors to help addicts choose
treatment that will work for them. The Opioid Task Force and existing programs are also important moving
forward. Education efforts also need to continue.
FUNDING AND POLICY ISSUES
Funding and action plans submitted to address heroin use in the community include a behavioral health
treatment expansion grant. Medicaid expansion has allowed more people to receive treatment than previously.
The possible Harm Reduction/Needle exchange program, supported by the Mat-Su Opioid Task Force, EMS,
and clinics is a possibility, though it is too early to determine the direction of this effort. The State budget and
use of volunteers are also on community members’ minds.
EDUCATION
Education on current and future efforts may be best communicated through social media and other media
outlets, presentations in the community, and word of mouth. Education may be one day to combat
misconceptions about current heroin efforts, including misunderstanding of addiction as a choice, the idea that
no treatment is available, blame on SB91 for high crime, and the concept of harm reduction. Leadership in the
Mat-Su is involved, attending meetings and reception to education on options and how to be effective. Funding
and personnel are also needed for the issue, however.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 73
NEED TO TRACK AND EVALUATE COMMUNITY EFFORTS & SHARE DATA
To evaluation the effectiveness of strategies to address heroin, several measures are in place. These include
tracking of admissions, length of treatment, reasons for dropping out or being terminated by the program,
number of successful completions, and other data. A qualitative study of the program was also completed by a
PhD candidate for her dissertation. Other measures are utilized by THRIVE Mat-Su and through school surveys.
The data that is collected is considered accurate and it is felt the data should be made readily available and
community members should be educated on where to find it.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 74
Consumption
This chapter presents available data on consumption patterns of heroin. The only available consumption
patterns of heroin in recent years comes from the YRBS for high school students on life time heroin use.
Lifetime Heroin Use
All High School Students
In 2015, 3.1 percent of all Mat-Su high school students had ever used heroin, representing an estimated 134
students. The prevalence rate appears to have decreased since 2011, but there is no statistical difference
between any of the years.
Figure 28. Lifetime Heroin Use, All High School Students, Mat-Su, Percent, 2011, 2013, and 2015
4.2
3.1
2.9
2011
2013
2015
Source: YRBS.
Mat-Su appears to have a higher rate of use than statewide for all years of data, but there are no statistically
significant differences.
Figure 29. Lifetime Heroin Use, All High School Students, Mat-Su and Alaska, Percent, 2011, 2013, and
2015
Mat-Su
Alaska
4.2
3.1
2.2
2.4
2011
2013
2015
Source: YRBS.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 75
Traditional High School
In 2015, 1.6 percent of Mat-Su traditional high school students reported having ever used heroin in their lifetime,
which represents an estimated 62 students. The Mat-Su prevalence rate did not differ statistically between the
three survey years.
Figure 30. Lifetime Heroin Use, Traditional High School Students, Mat-Su, Percent,
2011, 2013, and 2015
3.1
2.4
2011
1.6
2013
2015
Source: YRBS.
For the 2011, 2013, and 2015 survey years, prevalence rates for lifetime heroin use did not differ statistically
between Mat-Su, Alaska, and the U.S among traditional high school students.
Figure 31. Lifetime Heroin Use, Traditional High School Students,
Mat-Su, Alaska, and U.S., Percent, 2011, 2013, and 2015
Mat-Su
3.1
Alaska
U.S.
2.9
2.1
2.2
2.4
1.6
2011
2013
2015
Source: YRBS.
In 2015, there were no other statistical differences when comparing Mat-Su traditional high school students to
Alaska and U.S. traditional students, nor when comparing to 2011 Mat-Su traditional high school students.
When comparing within Mat-Su traditional high school student in 2015, there were also no statistical difference
between males and females, race/ethnicity, grades or academic grades.
Mat-Su traditional high school students reported a lower percentage than Mat-Su alternative high school
students in overall prevalence (1.6 versus 14.0 percent), males (2.2 versus 15.1 percent), females (0.9 versus 12.7
percent), whites (1.4 versus 12.0 percent), Alaska Natives (0.7 versus 13.9 percent), 11th graders (1.2 versus 14.8
percent), 12th graders (2.4 versus 16.7 percent), students that received mostly As and Bs academic grades (0.9
versus 8.2 percent), and students that received mostly Cs, Ds, and Fs academic grades (3.3 versus 19.2 percent)
(p<.05).
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 76
Table 43. Lifetime Heroin Use, Traditional High School Students, Mat-Su, 2015
2015
Statistical difference between…?
Mat-Su and
Mat-Su and
Mat-Su Trad. and MatAlaska Trad.
U.S. Trad.
Su Alt. Students
Students
Students
Percent
Mat-Su 2015 and
2011 Trad.
Students
1.6




Male
2.2
Female
0.9








White (Non-Hispanic,
Single Race Only)
1.4


Alaska Native
0.7
NA


Other Races
3.9




NA
NA
NA












NA


NA
NA
NA
NA


Demographics
Overall Prevalence
Gender
Race/Ethnicity
Grade Level
9th Grade
1.1
10th Grade
2.0
11th Grade
1.2
12th Grade
2.4
NA


Academic Grades
Mostly As and Bs
0.9
Mostly Cs, Ds, Fs,
3.3
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Alternative High School
In 2015, 14.0 percent of Mat-Su alternative high school students reported having ever used heroin, representing
an estimated 62 students. The Mat-Su prevalence rate for alternative high school students did not differ
statistically between any of the years presented.
Figure 32. Lifetime Heroin Use, Alternative High School Students, Mat-Su, Percent,
2011, 2013, and 2015
14.0
12.0
2011
9.3
2013
2015
Source: YRBS.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 77
While Mat-Su alternative high school students consistently reported slightly higher percentages than statewide
alternative high school students, there were no statistical differences for all years presented.
Figure 33. Lifetime Heroin Use, Alternative High School Students,
Mat-Su and Alaska, Percent, 2011, 2013, and 2015
Mat-Su
14.0
12.0
11.0
10.1
2011
Alaska
2013
2015
Source: YRBS
In 2015, there were no other statistical differences when comparing Mat-Su alternative high school students to
Alaska alternative students, nor when comparing to 2011 Mat-Su alternative high school students. When
comparing within Mat-Su alternative high school student in 2015, there were also no statistical differences
between males and females, race/ethnicity, or grade level. However, in 2015, Mat-Su alternative high school
students receiving mostly Cs, Ds, and Fs academic grades reported a rate nearly 2 times higher (19.2 percent)
than Mat-Su alternative high school students receiving mostly As and Bs academic grades (8.2 percent) (p<.05).
Overall, Mat-Su alternative high school students reported a statistically higher prevalence than Mat-Su
traditional high school students for all comparisons. Mat-Su alternative high school students reported a higher
percentage than Mat-Su traditional high school students in overall prevalence (9 times higher: 14. 0 versus 1.6
percent), males (7 times higher: 15.1 versus 2.2 percent), females (14 times higher: 12.7 versus 0.9 percent),
whites (9 times higher: 12.0 versus 1.4 percent), Alaska Natives (20 times higher: 13.9 versus 0.7 percent), 11th
graders (12 time higher: 14.8 versus 1.2 percent), 12th graders (7 times higher: 16.7 versus 2.4 percent), students
that received mostly As and Bs academic grades (9 times higher: 8.2 versus 0.9), and students that received
mostly Cs, Ds, and Fs academic grades (6 times higher: 19.2 versus 3.3 percent) (p<.05).
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 78
Table 44. Lifetime Heroin Use, Alternative High School Students, Mat-Su, 2015
2015
Demographics
Percent
Statistical difference between…?
Mat-Su 2015
Mat-Su and
Mat-Su Alt. and
and 2011 Alt.
Alaska Alt.
Mat-Su Trad.
Students
Students
Students
14.0



Male
15.1
Female
12.7






White (Non-Hispanic,
Single Race Only)
12.0

Alaska Native
13.9
NA




-
NA
NA
NA
9th Grade
-
NA
NA
NA
10th
-
NA
NA
NA
11th Grade
14.8

12th Grade
16.7
NA




Mostly As and Bs
8.2
NA
Mostly Cs, Ds, Fs,
19.2




Overall Prevalence
Gender
Race/Ethnicity
Other Races
Grade Level
Grade
Academic Grades
NA
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Community Needs Assessment
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McDowell Group, Inc.  Page 79
Consequences
This chapter presents available data on consequences associated with heroin use. It summarizes emergency
discharges related to heroin use, deaths and arrests for charges.
Emergency Department Discharges
In 2015, 19 discharges from the Mat-Su ED were related to heroin, all of which were poisonings. They occurred
at a rate of 0.6 per 1,000 discharges. Throughout all of Alaska, heroin-related discharges occurred at a rate of
0.4 per 1,000 discharges.
Males and Mat-Su residents age 18-25 accounted for a slightly higher share of heroin-related discharges
disproportionately large relative to their share of the population. Males represent 51.8 percent of the Mat-Su
population yet accounted for 57.9 percent of heroin-related discharges. Similarly, Mat-Su residents age 18-25
represent 11.9 percent of the population but accounted for 42.1 percent of heroin-related discharges. Statewide
data exhibit the same patterns.
Table 45. Number of Heroin-Related ED Discharges and Rate per 1,000 ED Discharges,
Ages 12+, Mat-Su and Alaska, 2015
Mat-Su
Alaska
29,682
279,971
Heroin-related discharges (count)
19
104
Rate of heroin-related discharges per 1,000 discharges
0.6
0.4
All ED discharges (count)
Source: HFDR.
Table 46. Number of Heroin-Related Discharges and Percent of Population,
by Type, Gender, and Age, Ages 12+, Mat-Su and Alaska, 2015
#
% of
Total
Mat-Su
% of
Population
Age 12+
Population
Age 12+
#
% of
Total
Alaska
% of
Population
Age 12+
Population
Age 12+
Heroin-Related Discharges
Type
Poisoning
19
100.0
–
–
104
100.0
–
–
Other
0
0.0
–
–
0
0.0
–
–
Male
11
57.9
51.8
42,043
76
73.1
51.9
326,995
Female
8
42.1
48.2
39,176
28
26.9
48.1
303,412
12-17
0
0.0
11.1
8,983
0
0.0
12.7
79,749
18-25
8
42.1
11.9
9,679
35
33.7
13.3
83,804
26+
11
57.9
77.0
62,557
69
66.3
74.1
Total
19
81,219
104
Gender
Age
466,854
630,407
Source: HFDR, DOLWD.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 80
Deaths
Between the years 2009 and 2013, opiates caused 63 deaths in Mat-Su for residents of all ages at an average of
16 deaths per year. Other opioids, which include non-prescription opiates such as opium and heroin, accounted
for 7 of those deaths.
Table 47. Number of Prescription Opioid Deaths, Other Opioid Deaths,
and Total Opioid Deaths, Mat-Su, 2009-2013
Prescription opioid deaths
# of Deaths
(2009-2013)
56
Annual Average
Rate per 10,000 Population
11
.25
Other opioid deaths
7
1
.03
Total opioid deaths
63
13
.28
Source: CDC WONDER.
Arrests
In 2015, Mat-Su law enforcement made 70 opioid-related arrests. Arrests for possession (misconduct involving
a controlled substance in the 4th degree) comprised the majority (39 arrests) of these arrests. Arrests for
manufacturing, delivery, or intent to distribute (misconduct involving a controlled substance in the 2nd degree)
accounted for almost half of all opioid-related arrests.
Table 48. Number of Arrests for Misconduct Involving
Schedule IA Controlled Substances, Mat-Su, 2015
Violation
Number of Arrests
Misconduct involving a controlled substance in the 1st degree
Misconduct involving a controlled substance in the
2nd
degree
Misconduct involving a controlled substance in the
3rd
1
29
degree
1
Misconduct involving a controlled substance in the 4th degree
39
Total Arrests
70
Source: THRIVE Mat-Su.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 81
Risk & Protective Factors
This chapter presents indicators that may protect or contribute to heroin use. It summarizes perceptions of
heroin as a community problem, perceptions of risk, and heroin availability.
Community Problem
In 2015, 42.7 percent of Mat-Su adults ages 18-25 rated heroin a very large problem in the local community
compared with 31.6 percent of statewide young adult respondents.
Figure 34. Perception of Heroin as a Community Problem, Mat-Su and Alaska, 2015
Mat-Su
Alaska
6 A very large problem
14.7
5
7.7
4
18.6
11.6
14.0
15.7
3
8.4
8.7
2
11.9
12.7
1 Not a problem at all
No response
42.7
31.6
0.7
1.2
Source: YASUS.
Risk of Harm
In 2015, more than 72.0 percent of Mat-Su adults ages 18-25 rated trying heroin once or twice as a great risk.
This is higher than the statewide percentage reporting 66.4 percent.
Table 49. Risk of Harm When People Try Heroin, Mat-Su and Alaska, 2015
Question
Mat-Su
Alaska
How much do people risk harming themselves physically or in other ways when they try heroin
once or twice?
Responses
Number
Percent
Number
Percent
1 No risk
5
3.5
30
3.9
2
3
2.1
14
1.8
3
6
4.2
34
4.4
4
9
6.3
67
8.6
5
16
11.2
113
14.5
6 Great risk
103
72.0
517
66.4
1
0.7
4
0.5
143
100.0
779
100.0
No response
Total respondents
Source: YASUS.
Community Needs Assessment
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McDowell Group, Inc.  Page 82
In, 2015, 86.0 percent of Mat-Su adults ages 18-25 considered it a great risk to regularly use heroin once or
twice per week compared to 81.0 percent statewide.
Table 50. Risk of Harm When People Regularly Use Heroin, Mat-Su and Alaska, 2015
Question
Mat-Su
Alaska
How much do people risk harming themselves physically or in other ways when they regularly
use heroin once or twice per week?
Responses
Number
Percent
Number
Percent
1 No risk
3
2.1
23
3.0
2
1
0.7
11
1.4
3
4
2.8
20
2.6
4
6
4.2
29
3.7
5
5
3.5
62
8.0
123
86.0
631
81.0
1
0.7
3
0.4
143
100.0
779
100.0
6 Great risk
No response
Total respondents
Source: YASUS.
Heroin Availability
Between 2002 and 2011, among Mat-Su residents ages 12+ reporting heroin use, 15.0 percent reporting it was
“fairly easy” to obtain and 4.8 percent reported it as “very easy” to obtain. When compared to Alaska, there were
no statistical difference. However, Mat-Su reported a higher rate (21.3 percent) than nationally that was “fairly
difficult” to obtain. While the only data available, availability patterns may have changed in recent years.
Table 51. Mat-Su Heroin Availability. 2002-2011
Mat-Su
Prevalence
Estimated
Number of
Mat-Su
Residents
Impossible
36.6
755
Very difficult
22.3
460
Fairly difficult
21.3
439
Fairly easy
15.0
309
Very easy
4.8
99
Description
Difference
Between MatSu and Alaska
Difference
Between MatSu and U.S.










Difficulty in getting heroin
Source: NSDUH.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 83
Community Factors
The State of Alaska selected perceived risk for harm of heroin as a key intervening variable. Because intervening
variables are broad concepts that manifest differently in different communities, 85 identification of local,
community factors that affect how the intervening variables emerge in each region is a crucial component of
the assessment phase. Understanding the local context sets the foundation for an effective logic model and
ultimately the selection of strategies that precisely target regional issues.
To that end, THRIVE Mat-Su engaged in a facilitated session to identify and prioritize community factors that
impact perceived risk for harm from heroin. In addition, the group identified the social availability of heroin as
an additional intervening variable to address in the discussion. This section summarizes the results by each topic
area.
Perceived Risk of Heroin Use
Coalition members identified the following community factors related to the perceived risk of heroin use. The
list below reflects group-identified themes with associated sub-points in order of member prioritization.
•
•
Parent/Caregiver
o
Parent lack of education on the issue
o
Parent unawareness of child activities
o
Parent denial
Individual
o
•
People do not think addiction or problems with heroin will ever affect them
Community
o
Overall, Mat-Su perceives a high risk for heroin use
o
In some groups, heroin is taboo; in other groups, it is not
DHSS. (2016). Prevention of non-medical use of prescription opioids
http://www.iser.uaa.alaska.edu/Projects/pfs/docs/ PFSGuidanceDocument.pdf.
85
Community Needs Assessment
Heroin
and
heroin
use
in
Alaska.
Available
at:
McDowell Group, Inc.  Page 84
Figure 35. Community Factors that Impact the Perceived Risk of Heroin Use
Source: McDowell Group.
Social Availability of Heroin
Coalition members identified the following community factors related to the social availability of heroin. The list
below reflects group-identified themes with associated sub-points in order of member prioritization.
•
•
Accessibility/low cost
o
Cheap and easy to find
o
Small communities so young people know which parties will have heroin
o
Readily available on streets: Just go to [local business] parking lot
o
Gangs
o
Lack of other social activities
o
Peer pressure
At-risk youth not identified or falling through the cracks
o
•
Lack of knowledge
Lack of law enforcement
o
SB91 makes it so there is no punishment for possession
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 85
Figure 36. Community Factors that Impact the Social Availability of Heroin
Source: McDowell Group.
Community Needs Assessment
Heroin
McDowell Group, Inc.  Page 86
Prevention Resources Assessment
A number of organizations and programs provide services that may reduce the likelihood of prescription opioid
misuse or heroin use among youth and young adults in Mat-Su. These include programs that teach and model
healthy lifestyles and promote positive social relationships and norms, along with programs aimed at reducing
impacts of trauma and exposure to substance abuse. However, at the time of the writing of this report, none of
the programs explicitly employ strategies to prevent prescription opioid misuse or heroin use. The exceptions
are THRIVE Mat-Su and the Mat-Su Opioid Task Force. The former was funded to begin an explicit prevention
focus on this issue; and the latter has begun a process to focus on prevention through education using a direct
strategy related to presenting information to students, and has initiated a needle exchange program.
In January 2017, 13 members of THRIVE Mat-Su coalition (representing 11 organizations) took part in a
facilitated session to review preliminary data profile findings. This helped provide context for eliciting, defining,
and prioritizing community factors by identifying themes related to prescription opioid misuse and heroin use
in the community. THRIVE Mat-Su also reviewed programs and strategies offered in the Mat-Su by categorizing
them per the social ecology theory of change, placing them on the continuum of care for behavioral health, and
identifying them as evidence-based and/or asset building focus. (Detailed methodology for this prevention
mapping is under the Methodology chapter, Community Factors and Methods for Prevention Matrix).
Please note, this review process did not focus on treatment resources or harm reduction resources available in
the Mat-Su. While it did not focus on these, two efforts emerged in this process as important to recognize
related to these issues in the Mat-Su: 1) Statewide policy on naloxone, and 2) the Mat-Su Opioid Task Force.
Policy functions as an essential component of prevention. This assessment aimed to focus at a local-level rather
than state policy. However, key stakeholders recognized a statewide statute, passed in 2016, allows providers
to dispense the lifesaving drug naloxone, otherwise known as Narcan, over the counter without worry over civil
liability as an important step in influencing community-level prevention. This policy prevents opioid prescription
and heroin related deaths, though it is not a measure to prevent use of the substances in the first place.
The Mat-Su Opioid Task Force aims to end opioid abuse by creating a supportive system of partners, agencies,
and/or individuals to assist individuals and families to become “healthy, self-sufficient, and productive.” The
Mat-Su Opioid Task Force’s strategic objectives to date focused on harm reduction and treatment. Strategies
include:
1.
Expanding detox access
a.
2.
Including accessible programs with appropriate opioid withdrawal management
Creating a range of services on the continuum of care, including needle exchange and harm reduction
strategies
3.
Developing peer to peer community support
4.
Establishing a formal system of support, including housing, training, and wrap around services
5.
Formalizing the Prescription Drug Monitoring and/or other information exchange programs.
Prevention resources reviewed specific to the Mat-Su Borough are listed in the following table.
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 87
Table 52. Prevention Resources
Program
Description
Youth Ages
Type of Services
Camp Hope
Overnight camp for children living with
parental substance abuse
7-11
Life skills
Capturing Kids Hearts - MSBSD
Training school staff on connection with
youth
High school
Support, connection,
early identification
Girls on the Run
Self-esteem and exercise program
8-13
Life skills
Mat-Su Peer Helpers
Youth peers promoting a safe and healthy
atmosphere within their schools and
community
Middle and
high school
Peer support,
healthy lifestyles
MY House Mat-Su
Youth homeless shelters
14-24
Connection with
services, support,
employment training
Nine Star Youth Employment
Services
Assessment, skill upgrades, career
counseling, and pre-employment skills for
youth
14-24
Life skills
Royal Family Kids
Camp, club, and mentoring for foster
children
5-12
Life skills,
relationships
Set Free Alaska
Address youth behavioral health needs,
treating trauma, developing healthy
coping skills
5-17
Assessment,
treatment, therapy
Strengthening Families – CoOccurring Disorders Institute
Curriculum for families on family
interaction skills
3-10
Family support and
communication
The YAK (Youth of Alaska)
Faith-based youth after school
organization
Middle and
high school
Social connection,
positive life choices
THRIVE Mat-Su
Youth substance use prevention coalition
Youth &
Young Adults
Coalition
R.O.C.K. Mat-Su
Effort for creation of a safe, nurturing
environment for children and families
All
Trauma reduction
Alaska Center for Resource
Families
Training and support for foster and
adoptive parents
All
Trauma reduction
Alaska Family Services – Family
Support and Preservation
Parenting and family support services,
including Turn Around Youth and Adult
Evening Program and A.S.AP.
All
Trauma reduction
Big Brothers/Big Sisters
Youth mentoring
All
Life skills,
connection
MSBSD
Health curriculum, drug/alcohol policy,
mental health counselors, traumainformed schools, Capturing Kids Hearts
and Social Emotional Learning curriculum
All
Mental health
support, education,
policy
Positive Community Norms
Media Campaign – Alaska
Wellness Coalition/THRIVE MatSu
Positive community norms, focus on
underage drinking
All
Positive life choices
Screening, Brief Intervention, and
Referral to Treatment
Health professionals: early identification
and intervention for substance misuse
All
Training, for
screening and early
intervention
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 88
Recommendations and Next Steps
These next steps and recommendations evolved from reviewing current conditions in the Mat-Su, attending
and facilitating coalition meetings, and discussions with THRIVE staff.
Community-Level Recommendations and Next Steps
WORK WITHIN THE APPROPRIATE LEGAL AND POLICY PROCESS TO ESTABLISH PERMANENT DROP OFF LOCATIONS FOR
EXCESSIVE PRESCRIPTIONS DRUGS.
•
When people can readily dispose of drugs they do not need, it reduces the social availability of
prescription drug misuse. Currently, prescription drug drop-off opportunities are limited (number of
hours and days of operation) and ad hoc, relying on community members to develop and maintain
them.
DEVELOP A MEDIA CAMPAIGN, LEVERAGING SUCCESSFUL NATIONAL MEDIA CAMPAIGN METHODS, TO SHIFT RISK PERCEPTION
AND MISINFORMATION AROUND PRESCRIPTION DRUG MISUSE ACROSS ALL AGE GROUPS.
•
While this grant is focused on the 12-25 age group, it is important to recognize that parents,
grandparents, and elders in the community play critical roles in youth access to prescription drugs. The
campaign should focus on all ages to dispel misperceptions that drugs prescribed by doctors are safe,
and increase awareness of the risks and best practices around prescription opioid use. Providers need
to share information with patients about the risks of prescription opioid use (such as addiction and
heroin use), how to dispose of unused drugs, and how to store them safely at home.
FOCUS MAJORITY OF EFFORTS ON THE PREVENTION OF PRESCRIPTION DRUG MISUSE AS THIS MISUSE IS OFTEN A PREDICTOR
OF HEROIN USE.
•
National research and qualitative responses indicate people move to heroin use after prescription drug
misuse. While the grant focuses on heroin as well as prescription drug misuse, the focus on prescription
drug misuse will likely lead to a decrease in heroin use over time.
DEVELOP TARGETED PREVENTION STRATEGIES TO DISPEL MYTHS THAT ONLY CERTAIN POPULATIONS ARE A RISK FOR
PRESCRIPTION DRUG MISUSE OR HEROIN USE.
•
Mat-Su data and coalition conversations indicate the risk perception of heroin use being dangerous is
well recognized. However, qualitative discussions about risk perception differ for certain populations
who do not perceive they, their children, or their neighbors are at risk because of their misperceptions
that heroin use is only an issue for certain populations within certain social strata.
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 89
BUILD UPON STRENGTHS OF BEING RURAL AND A CLOSE-KNIT COMMUNITY CONNECTEDNESS TO REDUCE USE. SEEK OUT
NATIONALLY-TESTED ENVIRONMENTAL PREVENTION STRATEGIES USED IN OTHER RURAL AREAS AND ADAPT THEM TO
ALASKA.
•
National literature recognizes prescription drug misuse is more common in rural areas. Coalition
discussions around community norms identified rural connectedness was both a strength and a
weakness. As a weakness, a small community can provide an easy distribution channel. It can also be
hard to say no to distribution, as people one knows may say they are in pain and need help.
Long-Term Community Recommendations
CONTINUE TRACKING DATA PRESENTED IN THIS REPORT.
•
While the data in the report presented many challenges ranging from small numbers, coding issues,
and large time spans, consider continuing to collect and report this information. It can serve as a critical
baseline of information for tracking and evaluation of community level efforts on these issues.
CONTINUE TO BUILD DATA CAPACITY FOR COLLECTING, SHARING AND ROUTINELY REPORTING DATA ON PRESCRIPTION DRUG
MISUSE AND HEROIN USE.
•
The data presented in this report does not resonate with the personal experiences within the Mat-Su.
Many coalition members felt there was a disconnect between data presented in this report and the
impact prescription drug misuse and heroin are having in the community. Additionally, while it was
recognized this is a prevention grant, coalition members also felt efforts should be made to collect and
report treatment data as it represents another signal of the problem in the community.
Next Step:
o
Collect treatment data to complement or supplement other population-level data collected in
this report. This, and the shared experiences of coalition members, may capture a broader
perspective of the prescription drug misuse and heroin use to allow for different prevention
strategies.
ESTABLISH RELATIONSHIPS WITHIN THE EMERGENCY RESPONSE SYSTEM LOCALLY AND DRAW UPON NATIONAL EFFORTS TO
BETTER CAPTURE THE IMPACT OF THIS ISSUE.
•
The rate of emergency department visits from the Alaska Hospital Discharge Data System did not
resonate with community members or emergency department providers. From the provider side,
currently when patients are coming into the emergency department, patients are coded with the disease
or issue present, such as abscess in the arm or constipation. There is not a financial incentive to code
for prescriptions drug misuse unless it is an obvious poisoning and often providers cite they do not
have the time to go through and code for other issues. From the emergency response system, currently
911 call data are not specific to poisoning and overdose reasons. These categories are only specified if
the caller reveals it. Additionally, the emergency response data does not always capture any of the
reasons for the response.
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 90
Next Steps:
o
Initiate efforts to better define emergency department definitions, coding, and reporting.
o
Work with local providers to understand how they are coding these issues within the emergency
department
o
Consider looking nationally to see if there are efforts to increase the coding of prescription
drug misuse and heroin.

Are there already created best practices?

Are there national standards that could be implemented locally or statewide for
recognizing prescription drug misuse?

Are there other rates of emergency department visits that should be captured rather
than poisonings alone?

A local provider recommended calculating the abscesses cleaning rate in the arm as a
signal of heroin use.
o
Initiate efforts within Mat-Su Borough Emergency Response system to better capture
prescription drug misuse and heroin.

Research national standards that could serve as a potential model across the 911
system and the response data systems. Work with Emergency Response to implement
a model tailored for the Mat-Su.
o
Consider working with the Mat-Su Regional Medical Center to better understand how these
patients are being coded. This includes chart review and key stakeholder interviews.
o
Over the life of the grant, work to obtain local level emergency department data.
Long-Term Statewide Recommendations
SUPPORT THE RECOMMENDATIONS FROM THE ALASKA OPIOID TASK FORCE.
•
The PFS grantee funds are focused on Policy, Systems and Environmental Strategies (PSE). As part of
PSE strategies, laws and policies play a critical role in prevention.
Next Steps:
o
THRIVE Mat-Su should consider a multi-level strategy to engage, advocate, and provide
community level perspectives to policy makers around the Governor’s bill to combat opioid
abuse (House 159 and Senate 79).
o
THRIVE Mat-Su coalition should consider reviewing this and identifying community level efforts
to work towards for some of the recommendations.
CONSIDER THE USE OF PRESCRIPTION DRUG MONITORING SYSTEMS DATA TO INFORM PUBLIC AND COMMUNITIES LOCAL
LEVEL PREVENTION ACTIVITIES.
•
The Partnerships for Success grantees are expected to impact the retail and social availability of
prescription opioids – essentially impact the market and demand of prescription opioids. However,
community coalitions do not have access to critical market information. Additionally, the Alaska
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 91
Prescription Drug Monitoring System (PDMPOS) data are not available to the public and communities
for local level action. This makes it extremely difficult for communities to develop actionable strategies
as they have little knowledge of how the market of these products operates in the community. While
PDMP were initially developed for providing medical care, they are well positioned to serve as tool for
communities to understand the market and make impactful community level changes with data
reported at a community level.
Next Steps:
o
THRIVE Mat-Su should consider advocating legislatures and leaders that the PMPD can also be
used for standard community level reports of the data. Work towards establishing this data as
part of standard public health practice reporting along with the prevalence of diabetes, alcohol
uses, injuries, and heart disease to develop environmental prevention strategies. Work with
legislators and other leaders to acquire and report this data in meaningful ways at the
community level for prevention planning. Data focus should be:

Who compose most subscribers by type?
•
Are these physicians, master-level nurses, veterinarians or others providers?

What is the age distribution of individuals receiving prescription opioids?

What is the distribution of the “high-utilizers” of prescriptions compared to the general
population?
•
How many people are the high-utilizers?

Average prescription rate per resident.

Geography – Where are people obtaining the prescription drugs?
•
Are people driving to Anchorage and accessing providers here?

Total number of doses dispensed in the community by year.

Total number of prescribers in the community and total number of patients receiving:
•
Average Quantity per Prescription
•
Average MED per prescription

Average distribution by month of year to understand season trends.

Percentage of prescribers enrolled in the PDMP.

Rate of multiple provider episodes and doctor shopping across the state by Mat-Su
residents.
Community Needs Assessment
Prevention Resources and Next Steps
McDowell Group, Inc.  Page 92
Appendix A: Data Tables
This appendix contains all the YRBS data used in this report. In the table headings below, CI denotes “Confidence
Interval.”
Middle School
Table 53. Prescription Drug Indicators, Middle School Students, Mat-Su and Alaska2015
Mat-Su
%
Past 30 Day Prescription Drug Use
Mat-Su CI
%
AK
%
AK CI
%
10.5
3.7-9.4
5.2
3.6-7.6
Male
10.0
3.8-10.9
5.9
3.7-9.1
Female
11.5
2.1-11
4.1
2.3-7.5
White (Non-Hispanic,
Single Race Only)
11.4
3.7-11.8
6.3
3.7-10.3
Alaska Native
10.6
3.1-13.5
4.9
2.9-8.2
Demographics
Overall Prevalence
Gender
Race/Ethnicity
Grade Level
7th Grade
7.6
1.9-6.1
3.1
2-4.9
8th Grade
12.7
4.7-13.2
7.0
4.5-10.7
Academic Grades
13 or Younger
7.6
2.3-6.3
3.6
2.4-5.4
14 and 15 Years of Age
15.6
5.5-16.5
8.1
5-12.8
Risk of Prescription Drug Use Moderate or Great
Overall Prevalence
75.4
69.4-80.5
72.2
67.6-76.4
Male
73.7
66.8-79.6
71.0
65.5-76
Female
79.2
70.5-85.8
74.6
68.3-80
White (Non-Hispanic,
Single Race Only)
75.2
67.3-81.7
76.9
70.3-82.4
Alaska Native
72.7
60.4-82.4
62.2
54.9-69
7th Grade
74.7
63.8-83.2
71.5
63.6-78.2
8th Grade
75.9
68-82.4
72.9
66.4-78.5
13 or Younger
76.3
67.8-83.1
73.5
67.5-78.8
14 and 15 Years of Age
73.7
62.6-82.4
69.8
61.4-77
Gender
Race/Ethnicity
Grade Level
Academic Grades
Parents Consider Prescription Drug Use Wrong or Very Wrong
Overall Prevalence
87.6
83.9-90.6
88.1
85.5-90.3
Male
87.0
82-90.7
87.4
83.7-90.4
Female
89.1
82.2-93.5
89.4
85.2-92.5
Gender
Race/Ethnicity
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 93
Mat-Su
%
Mat-Su CI
%
AK
%
AK CI
%
White (Non-Hispanic,
Single Race Only)
88.9
83.1-92.8
88.9
84.3-92.3
Alaska Native
85.7
73.7-92.8
87.4
82.1-91.3
7th Grade
90.8
86-94
90.8
87.6-93.2
8th
85.3
79.7-89.6
86.0
81.9-89.3
13 or Younger
90.1
85.4-93.3
89.9
86.8-92.4
14 and 15 Years of Age
83.4
73.5-90.1
84.8
77.9-89.9
Demographics
Grade Level
Grade
Academic Grades
Friends Consider Prescription Drug Use Wrong or Very Wrong
Overall Prevalence
73.1
67.3-78.1
73.6
69.5-77.3
Male
73.0
66.6-78.6
74.3
69.3-78.7
Female
73.1
63.7-80.8
72.2
66.1-77.6
White (Non-Hispanic,
Single Race Only)
73.6
65.2-80.5
73.3
66.4-79.3
Alaska Native
76.4
67.1-83.8
76.4
70.8-81.3
7th Grade
76.2
70.1-81.5
76.1
71.6-80.1
8th
70.7
61.2-78.6
71.6
64.8-77.5
13 or Younger
75.7
70.3-80.5
76.0
72-79.6
14 and 15 Years of Age
68.4
55.3-79.1
69.2
59.2-77.1
Gender
Race/Ethnicity
Grade Level
Grade
Age Group
Source: YRBS.
Table 54. Prescription Drug Indicators, Middle School Students, Mat-Su and Alaska, 2011 and 2015
2011
Mat-Su
%
2011
Mat-Su CI
%
2015
Mat-Su
%
2015
Mat-Su CI
%
2015
AK
%
2015
AK CI
%
15.4
13.2-17.8
10.5
7.8-14
9.4
7.4-11.9
Male
16.3
13.4-19.7
10.0
6.4-15.3
9.2
6.4-13
Female
13.9
11.2-17.1
11.5
7.63-16.8
9.7
7.2-13
White (Non-Hispanic,
Single Race Only)
12.6
10.3-15.4
11.4
8-16.1
10.4
7.6-14.2
Alaska Native
18.3
13.4-24.5
10.6
5.6-19.3
9.2
6.2-13.4
7th Grade
12.5
9.6-16.1
7.6
4.8-11.8
7.3
5.3-10.2
8th
17.8
15.2-20.9
12.7
9-17.6
11.2
8.3-14.9
13 or Younger
13.7
9.8-18.9
7.6
5.4-10.6
7.3
5.6-9.5
14 and 15 Years of Age
15.8
13.6-18.2
15.6
11.3-21.1
13.2
9.9-17.5
Demographics
Prescription Drug Use Ever
Overall Prevalence
Gender
Race/Ethnicity
Grade Level
Grade
Age Group
Source: YRBS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 94
High School
Table 55. Prescription Drug Indicators, All, Traditional and Alternative High School Students, Mat-Su 2011 and 2015, and Alaska and U.S., 2011 and 2015
2011
2011
Mat-Su
Mat-Su
ALL
ALL
%
CI %
Current Prescription Drug Use
Demographics
Overall
Prevalence
2015
Mat-Su
ALL
%
2015
Mat-Su
ALL
CI %
2011
Mat-Su
TRAD
%
2011
Mat-Su
TRAD
CI %
2015
Mat-Su
TRAD
%
2015
Mat-Su
TRAD
CI %
2011
Mat-Su
ALT
%
2011
Mat-Su
ALT
CI %
2015
Mat-Su
ALT
%
2015
Mat-Su ALT
CI %
2015
AK
TRAD
%
2015
AK
TRAD
CI %
2015
AK ALT
%
2015
AK ALT
CI %
2015
US
TRAD
%
2015
US
TRAD
CI %
24.2-29.5
20.1
15.4-25.7
6.4
5.1-8
19.8
17.2-22.7
NA
NA-NA
11.5
8.86-14.89
8.4
6.9410.16
9.7
7.1-13
6.9
5.2-9
26.7
Male
NA
NA-NA
NA
NA-NA
9.5
6.4-13.8
6.2
3.9-9.7
31.7
26-38.1
19.4
14.1-26.2
6.60
4.9-8.9
18.0
14.7-21.8
NA
NA-NA
Female
NA
NA-NA
NA
NA-NA
9.9
6.5-14.7
7.7
5-11.8
21.9
18.7-25.5
20.9
14.9-28.5
5.80
4.1-8.1
20.8
17-25.2
NA
NA-NA
White (NonHispanic,
Single Race
Only)
NA
NA-NA
NA
NA-NA
8.3
5.7-11.9
7.7
5.7-10.4
27.5
24.1-31.1
18.1
12.9-24.8
5.60
3.9-7.9
20.9
17-25.3
NA
NA-NA
Alaska
Native
NA
NA-NA
NA
NA-NA
9.6
4.7-18.6
5.8
3.2-10.4
NA
NA-NA
16.1
9.4-26.3
4.10
2.3-7.3
16.2
12.4-20.8
NA
NA-NA
Other Races
NA
NA-NA
NA
NA-NA
15.3
9-24.8
5.2
2.3-11.2
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
9th Grade
NA
NA-NA
NA
NA-NA
9.4
5.9-14.8
7.5
4.7-11.8
NA
NA-NA
NA
NA-NA
2.90
1.7-5
16.8
11.4-24
NA
NA-NA
10th Grade
NA
NA-NA
NA
NA-NA
8.1
4.3-14.8
7.8
5-12
NA
NA-NA
NA
NA-NA
7.80
5.3-11.3
16.9
11.4-24.3
NA
NA-NA
11th Grade
NA
NA-NA
NA
NA-NA
10.2
4.8-20.3
6.9
3.9-11.9
21.6
16-28.5
21.5
15.7-28.7
5.70
3.6-9
19.8
15.4-25
NA
NA-NA
12th Grade
NA
NA-NA
NA
NA-NA
11.3
6.9-18
4.7
2.6-8.6
NA
NA-NA
21.6
14.1-31.7
8.50
5.3-13.4
21.1
17-25.9
NA
NA-NA
Mostly As
and Bs
NA
NA-NA
NA
NA-NA
7.3
4.6-11.5
4.5
3.3-6.2
30.8
23.9-38.7
16.2
11.4-22.6
NA
NA-NA
NA
NA-NA
NA
NA-NA
Mostly Cs,
Ds, and Fs
NA
NA-NA
NA
NA-NA
15.0
10.9-20.3
12.2
8.2-17.8
23.8
21.8-26
23.8
17.8-31.1
NA
NA-NA
NA
NA-NA
NA
NA-NA
21.4
17.78-25.57
17.7
14.8721.02
18.2
15-21.9
15.0
11.8-18.9
45.1
39.9-50.4
39.4
34.7-44.3
14.6
12.5-17.1
37.4
34.2-40.7
16.8
15.4-18.2
Male
NA
NA-NA
NA
NA-NA
17.9
13.9-22.7
14.6
10.9-19.3
48.8
39.3-58.4
37.6
32.2-43.3
15.60
12.8-19
35.4
31-40
17.8
16.1-19.6
Female
NA
NA-NA
NA
NA-NA
18.6
14.1-24.1
15.5
10.9-21.8
41.4
37.8-45.2
41.4
33.3-50.1
13.10
10.4-16.5
39.4
34.6-44.5
15.6
14.3-17.1
NA
NA-NA
NA
NA-NA
16.9
13-21.6
16.8
12.9-21.5
47.5
39.2-55.9
38.7
32-45.8
14.10
11.2-17.6
43.9
39-49
16.5
14.7-18.5
Gender
Race/Ethnicity
Grade Level
Academic
Grades
Prescription Drug Use Ever
Overall
Prevalence
Gender
Race/Ethnicity
White (NonHispanic,
Single Race
Only)
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 95
2011
Mat-Su
ALL
%
2011
Mat-Su
ALL
CI %
2015
Mat-Su
ALL
CI %
2011
Mat-Su
TRAD
%
2011
Mat-Su
TRAD
CI %
2015
Mat-Su
TRAD
%
2015
Mat-Su
TRAD
CI %
2011
Mat-Su
ALT
%
2011
Mat-Su
ALT
CI %
2015
Mat-Su
ALT
%
2015
Mat-Su ALT
CI %
2015
AK
TRAD
%
2015
AK
TRAD
CI %
2015
AK ALT
%
2015
AK ALT
CI %
2015
US
TRAD
%
2015
US
TRAD
CI %
Alaska
Native
NA
NA-NA
NA-NA
24.9
16.1-36.4
13.4
8.2-21.2
NA
NA-NA
37.5
28.7-47.2
13.20
9.7-17.6
33.1
27.9-38.7
NA
NA-NA
Other Races
NA
NA-NA
NA
NA-NA
18.3
11.1-28.8
10.4
5.4-19.1
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
9th Grade
NA
10th Grade
NA
NA-NA
NA
NA-NA
16.0
11.4-21.9
11.4
6.4-19.3
NA
NA-NA
NA
NA-NA
6.40
4.3-9.6
24.8
17.8-33.4
13.0
11-15.3
NA-NA
NA
NA-NA
17.5
11.8-25.2
16.1
10.3-24.2
NA
NA-NA
NA
NA-NA
17.80
14.7-21.4
32.2
25.2-40.1
15.3
12.7-18.4
11th Grade
12th Grade
NA
NA-NA
NA
NA-NA
16.9
10.1-27
15.9
9.9-24.4
38.6
34.9-42.5
47.9
39.6-56.2
16.20
12-21.5
39.2
33.3-45.4
18.9
17.4-20.6
NA
NA-NA
NA
NA-NA
23.8
16.2-33.6
17.9
12.6-24.8
NA
NA-NA
40.4
33.2-48
18.60
13.9-24.5
40.7
35.4-46.1
20.3
18.1-22.7
Mostly As
and Bs
NA
NA-NA
NA
NA-NA
14.7
10.7-19.7
12.0
9-15.9
49.6
40.5-58.7
36.4
29.7-43.7
NA
NA-NA
NA
NA-NA
NA
NA-NA
Mostly Cs,
Ds, and Fs
NA
NA-NA
NA
NA-NA
26.6
21.2-32.7
21.7
15.9-29
42.0
36.9-47.4
41.5
36.7-46.6
NA
NA-NA
NA
NA-NA
NA
NA-NA
Demographics
2015
Mat-Su
ALL
%
N
Grade Level
Academic
Grades
Prescription Drug Misuse Moderate or Great Risk
Overall
Prevalence
NA
NA-NA
82.9
79.7285.6
NA
NA-NA
83.9
80.3-87
NA
NA-NA
73.8
68.3-78.6
78.7
75.5-81.7
75.1
72.0-78.0
NA
NA-NA
Male
NA
NA-NA
NA
NA-NA
NA
NA-NA
79.8
74.5-84.2
NA
NA-NA
73.8
68.6-78.4
74.8
70.6-78.5
76.9
72.6-80.6
NA
NA-NA
Female
NA
NA-NA
NA
NA-NA
NA
NA-NA
88.9
85.1-91.8
NA
NA-NA
73.7
65.3-80.8
83.0
79.4-86.1
73.7
68.9-78.1
NA
NA-NA
White (NonHispanic,
Single Race
Only)
NA
NA-NA
NA
NA-NA
NA
NA-NA
84.2
80.1-87.7
NA
NA-NA
74.3
68.3-79.6
87.9
84.6-90.6
76.8
72.4-80.8
NA
NA-NA
Alaska
Native
NA
NA-NA
NA
NA-NA
NA
NA-NA
83.5
76.5-88.7
NA
NA-NA
80.1
69.5-87.7
71.1
63.1-77.9
75.6
70.1-80.5
NA
NA-NA
Other Races
NA
NA-NA
NA
NA-NA
NA
NA-NA
83.4
74-89.8
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
9th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
85.1
80.1-89.1
NA
NA-NA
NA
NA-NA
76.9
69.1-83.2
67.7
58.5-75.7
NA
NA-NA
10th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
83.5
75.9-89
NA
NA-NA
NA
NA-NA
79.4
74-83.9
78.7
71.1-84.7
NA
NA-NA
11th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
81.1
73.9-86.7
NA
NA-NA
75.5
66.6-82.6
81.4
75.4-86.2
77.1
71.2-82.1
NA
NA-NA
12th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
86.3
80.1-90.8
NA
NA-NA
71.7
61.9-79.9
77.6
70.3-83.6
74.5
69.4-79
NA
NA-NA
Mostly As
and Bs
NA
NA-NA
NA
NA-NA
NA
NA-NA
85.9
81.7-89.3
NA
NA-NA
72.6
60.7-82
NA
NA-NA
NA
NA-NA
NA
NA-NA
Mostly Cs,
Ds, and Fs
NA
NA-NA
NA
NA-NA
NA
NA-NA
79.8
72.9-85.3
NA
NA-NA
73.6
66.2-79.8
NA
NA-NA
NA
NA-NA
NA
NA-NA
Gender
Race/Ethnicity
Grade Level
Academic
Grades
Parents View Prescription Drug Use as Wrong or Very Wrong
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 96
2011
Mat-Su
ALL
%
2011
Mat-Su
ALL
CI %
2015
Mat-Su
ALL
%
2015
Mat-Su
ALL
CI %
2011
Mat-Su
TRAD
%
2011
Mat-Su
TRAD
CI %
2015
Mat-Su
TRAD
%
2015
Mat-Su
TRAD
CI %
2011
Mat-Su
ALT
%
2011
Mat-Su
ALT
CI %
2015
Mat-Su
ALT
%
2015
Mat-Su ALT
CI %
2015
AK
TRAD
%
2015
AK
TRAD
CI %
2015
AK ALT
%
2015
AK ALT
CI %
2015
US
TRAD
%
2015
US
TRAD
CI %
NA
NA-NA
91.8
90.0493.29
NA
NA-NA
92.6
90.7-94.1
NA
NA-NA
86.2
80.7-90.4
91.1
88.9-92.9
86.8
84.2-89
NA
NA-NA
Male
NA
NA-NA
NA
NA-NA
NA
NA-NA
93.2
90.2-95.3
NA
NA-NA
87.9
79.3-93.2
90.0
87.1-92.3
86.1
82.3-89.2
NA
NA-NA
Female
NA
NA-NA
NA
NA-NA
NA
NA-NA
91.8
88.3-94.3
NA
NA-NA
84.3
79.7-88.1
92.7
89.7-94.9
88.6
85.1-91.4
NA
NA-NA
White (NonHispanic,
Single Race
Only)
NA
NA-NA
NA
NA-NA
NA
NA-NA
92.6
90.3-94.4
NA
NA-NA
86.2
79.5-91
94.1
91.9-95.8
86.4
82.4-89.6
NA
NA-NA
Alaska
Native
NA
NA-NA
NA
NA-NA
NA
NA-NA
90.2
84.1-94.1
NA
NA-NA
85.9
80.1-90.3
91.6
88.5-94
87.0
82.6-90.5
NA
NA-NA
Other Races
NA
NA-NA
NA
NA-NA
NA
NA-NA
94.7
89.9-97.3
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
9th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
93.0
89.7-95.3
NA
NA-NA
NA
NA-NA
89.9
84-93.8
91.7
84.8-95.6
NA
NA-NA
10th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
92.0
87.7-94.8
NA
NA-NA
NA
NA-NA
90.6
87.1-93.2
87.1
80.6-91.6
NA
NA-NA
11th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
93.2
89.4-95.7
NA
NA-NA
89.9
83.5-94
93.2
89.9-95.5
89.7
85.2-92.9
NA
NA-NA
12th Grade
NA
NA-NA
NA
NA-NA
NA
NA-NA
91.9
85.2-95.7
NA
NA-NA
84.1
75.8-90
91.7
87.1-94.7
84.0
79.4-87.7
NA
NA-NA
Mostly As
and Bs
NA
NA-NA
NA
NA-NA
NA
NA-NA
93.6
91.5-95.3
NA
NA-NA
85.0
75.8-91.2
NA
NA-NA
NA
NA-NA
NA
NA-NA
Mostly Cs,
Ds, and Fs
NA
NA-NA
NA
NA-NA
NA
NA-NA
89.9
86.4-92.6
NA
NA-NA
86.8
80.5-91.3
NA
NA-NA
NA
NA-NA
NA
NA-NA
4.2
2.86-6.18
3.1
2.04-4.64
3.1
1.9-5
1.6
0.8-3.4
12.0
9.5-15
14.0
10.9-17.7
2.2
1.3-3.5
11.0
9.1-13.2
2.1
1.5-2.8
Male
NA
NA-NA
NA
NA-NA
4.3
2.6-7.1
2.2
1.1-4.5
16.1
11.5-22
15.1
11.6-19.5
2.9
1.9-4.4
10.6
8.1-13.6
2.7
1.9-3.8
Female
NA
NA-NA
NA
NA-NA
1.6
0.6-4.6
0.9
0.2-3.7
8.0
4.8-13.1
12.7
8-19.5
1.0
0.4-2.4
9.8
7.3-13.1
1.2
0.9-1.8
White (NonHispanic,
Single Race
Only)
NA
NA-NA
NA
NA-NA
2.3
1.2-4.2
1.4
0.6-3.5
13.3
8.9-19.4
12.0
8.2-17.1
1.7
0.8-3.3
11.2
8.4-14.7
1.3
1-1.7
Alaska
Native
NA
NA-NA
NA
NA-NA
2.8
0.9-8.5
0.7
0.1-5
NA
NA-NA
13.9
8.4-22
0.8
0.5-1.3
8.6
6.1-12.1
NA
NA-NA
Other Races
NA
NA-NA
NA
NA-NA
6.7
2.9-14.8
3.9
1.6-9.1
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
NA
NA-NA
9th Grade
NA
NA-NA
NA
NA-NA
6.0
3.1-11.1
1.1
0.3-4
NA
NA-NA
NA
NA-NA
1.8
0.8-4.2
8.5
4.7-14.9
1.8
1.2-2.6
10th Grade
NA
NA-NA
NA
NA-NA
0.0
NA-NA
2.0
0.7-5.3
NA
NA-NA
NA
NA-NA
2.0
1-3.9
10.5
6-17.8
2.4
1.6-3.6
Demographics
Overall
Prevalence
Gender
Race/Ethnicity
Grade Level
Academic
Grades
Heroin Use Ever
Overall
Prevalence
Gender
Race/Ethnicity
Grade Level
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 97
2011
Mat-Su
ALL
%
2011
Mat-Su
ALL
CI %
2015
Mat-Su
ALL
%
2015
Mat-Su
ALL
CI %
2011
Mat-Su
TRAD
%
2011
Mat-Su
TRAD
CI %
2015
Mat-Su
TRAD
%
2015
Mat-Su
TRAD
CI %
2011
Mat-Su
ALT
%
2011
Mat-Su
ALT
CI %
2015
Mat-Su
ALT
%
2015
Mat-Su ALT
CI %
2015
AK
TRAD
%
2015
AK
TRAD
CI %
2015
AK ALT
%
2015
AK ALT
CI %
2015
US
TRAD
%
2015
US
TRAD
CI %
11th Grade
NA
NA-NA
NA
NA-NA
3.5
1.2-9.4
1.2
0.3-4.6
10.5
5.3-19.9
14.8
10.8-20.1
2.7
1.2-5.9
10.0
7-14
1.9
1.1-3
12th Grade
NA
NA-NA
NA
NA-NA
2.9
1-8.5
2.4
0.7-7.4
NA
NA-NA
16.7
12.3-22.2
1.0
0.3-3.1
12.1
9.2-15.8
1.9
1.3-2.9
Mostly As
and Bs
NA
NA-NA
NA
NA-NA
1.7
0.9-3.4
0.9
0.3-2.8
11.9
7.7-17.8
8.2
4.9-13.3
NA
NA-NA
NA
NA-NA
NA
NA-NA
Mostly Ds,
and Fs
NA
NA-NA
NA
NA-NA
6.1
3.2-11.2
3.3
1.5-6.9
11.8
8.2-16.7
19.2
15.2-24
NA
NA-NA
NA
NA-NA
NA
NA-NA
Demographics
Academic
Grades
Note: Other Races includes those who refused, reported unknown results and had missing responses.
Source: YRBS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 98
Appendix B: Young Adult Substance Use Survey
Table 56. Community Messaging About Prescription Opioids Seen
by Young Adults, Mat-Su and Alaska, 2015
Mat-Su
Alaska
Percent
Percent
Question
Number
Number
(%)
(%)
In your community, have you seen any of the following messages about prescription opioids
on the radio, TV, or on printed material such as poster or pamphlets? (multiple responses)
I have not seen any messages about
prescription opioids
58
40.6
384
49.3
Safe use of prescription opioids as
prescribed by a doctor
53
37.1
245
31.5
The safe disposal of leftover prescription
opioids
42
29.4
177
22.7
The risks of sharing prescription opioids
with others
38
26.6
166
21.3
The safe and secure storage of
prescription opioids
25
17.5
140
18
Another type of message about
prescription opioids
3
2.1
16
2.1
No response
1
0.7
4
0.5
143
100.0
779
100.0
Total Respondents
Source: YASUS.
Table 57. Discussions of Appropriate Opioid Use Between Providers/Pharmacists and Young Adults
Prescribed Opioids Within Past Three Years, Mat-Su and Alaska, 2015
Mat-Su
Alaska
Percent
Percent
Question
Number
Number
(%)
(%)
The last time you were prescribed opioids, did your doctor or pharmacist talk to you about any
of the following? (multiple responses)
Side effects or problems from use
22
53.7
125
59.5
Using pills as prescribed and not more
17
41.5
119
56.7
To not share pills with others
13
31.7
68
32.4
Expected benefits
12
29.3
60
28.6
Safe and secure storage of pills
9
22
54
25.7
Alternatives to prescription opioids
8
19.5
44
21
I do not remember
8
19.5
26
12.4
Specific treatment goals that included a
plan for stopping use
5
12.2
45
21.4
Risk of developing an opioid use disorder
or addiction
5
12.2
36
17.1
No response
2
4.9
9
4.3
41
100.0
210
100.0
Total respondents
Source: YASUS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 99
Table 58. Disposal of Leftover, Unused Prescription Opioids Among Young Adults
Prescribed Opioids Within Past Three Years, Mat-Su and Alaska, 2015
Mat-Su
Alaska
Percent
Percent
Question
Number
Number
(%)
(%)
The last time you had leftover, unused prescription opioids, what did you do with them?
(multiple responses)
I still have them
23
56.1
110
52.4
I have never had any leftover
9
22
56
26.7
I flushed them down the toilet or sink
4
9.8
21
10
I gave them to a family member or friend
for free
3
7.3
12
5.7
I threw them in the trash
2
4.9
13
6.2
I disposed of them at a drug "take back"
program
2
4.9
11
5.2
I sold them to a family member or friend
0
0
0
0
I sold them on the street
0
0
0
0
I brought them to a pharmacy
0
0
3
1.4
Other
0
0
1
0.5
No response
0
0
1
0.5
41
100.0
210
100.0
Total respondents
Source: YASUS.
Table 59. Perception of Prescription Opioid Misuse as a Community Problem, Mat-Su and Alaska, 2015
Mat-Su
Alaska
Percent
Percent
Question
Number
Number
(%)
(%)
How much of a problem is prescription opioid misuse (using without a prescription or in other
ways other than as prescribed) in your community?
1 Not a problem at all
16
11.2
87
11.2
2
14
9.8
86
11.0
3
29
20.3
161
20.7
4
23
16.1
151
19.4
5
26
18.2
136
17.5
6 A very large problem
35
24.5
154
19.8
No response
0
0.0
4
0.5
143
100.0
779
100.0
Total respondents
Source: YASUS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 100
Table 60. Perception of Heroin as a Community Problem, Mat-Su and Alaska, 2015
Mat-Su
Percent
Question
Number
(%)
How much of a problem is heroin in your community?
Alaska
Percent
Number
(%)
1 Not a problem at all
17
11.9
99
12.7
2
12
8.4
68
8.7
3
20
14.0
122
15.7
4
11
7.7
90
11.6
5
21
14.7
145
18.6
6 A very large problem
61
42.7
246
31.6
No response
1
0.7
9
1.2
143
100.0
779
100.0
Total respondents
Source: YASUS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 101
Appendix C: Data Source Descriptions
American Community Survey (ACS)
The U.S. Census Bureau administers the American Community Survey (ACS). The survey includes a wide range
of information on demographic, social, economic, and housing characteristics. The ACS is provided in annual,
three-year, and five-year estimates. This report displays the 2011-2015 five-year estimates. This estimate
provides a larger sample and, thus, the best estimates for geographic areas depicted in this report.
Youth Risk Behavior Survey (YRBS)
The Youth Risk Behavior Survey (YRBS) is a risk-based survey administered to Mat-Su middle school students
(grades 7 and 8) and high school students (grades 9 through 12) regarding risk-related behaviors every other
year. The nationwide survey assesses youth risk in six main areas:
1.
Behaviors that contribute to unintentional injuries and violence
2.
Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases including
HIV infection
3.
Alcohol and other drug use
4.
Tobacco use
5.
Unhealthy dietary behaviors
6.
Inadequate physical activity
This report includes data from middle schools and all high schools, including traditional and alternative. The
following table exhibits the categories of YRBS data as well as the years and demographic breakouts available.
Detailed data including confidence intervals. Estimated number of students the prevalence represents can be
found in the appendixes.
Table 61. Available Years and Demographic Breakouts of YRBS Data, by School Type and Region
School
Type and
Region
Years Available
Middle Schools
Overall
Prevalence
By Gender
By Race/
Ethnicity
By Grade
Level
By Academic
Grades/Age
Groups
Mat-Su
2015





Alaska
2015






Alternative High Schools
Mat-Su
2011, 2013, 2015




Alaska
2011, 2013, 2015




Traditional High Schools
Mat-Su
2011, 2013, 2015




Alaska
2011, 2013, 2015




U.S.
2011, 2013, 2015





All High Schools
Mat-Su
2011, 2013, 2015


Alaska
2011, 2013, 2015


Source: YRBS.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 102
Methodology
Prevalence rates and confidence intervals were presented as provided. The estimated number of affected
students was calculated by applying the prevalence rates to October enrollment counts. Enrollment counts were
drawn from DEED. For every survey year, enrollment totals represent enrollment at the schools sampled by
YRBS. Since these totals represent only the schools sampled by YRBS and not the entire Mat-Su Borough School
District (MSBSD), the estimated number of affected students is a conservative measure.
Table 62. October 1 Enrollment Totals for MSBSD Middle Schools
Sampled by YRBS (7th and 8th Grade Only), School Year 2014-2015
Oct 2014
Enrollment
439
School
Colony Middle School
Houston Middle School
234
Palmer Middle School
417
Susitna Valley
57
Teeland Middle School
477
Valley Pathway
35
Wasilla Middle School
498
Total
2,157
Source: YRBS and DEED.
Table 63. October 1 Enrollment Totals for MSBSD High Schools Sampled by YRBS,
Alternative, Traditional, and All High Schools, School Years 2010-2011, 2012-2013, and 2014-2015
School Type and School
Traditional Schools
Alaska Middle College School
Years Included
in YRBS
Oct 2010
Enrollment
Oct 2012
Enrollment
Oct 2014
Enrollment
2015
-
-
93
Colony High School
2011, 2013, 2015
1,204
1,109
901
Glacier View School
2011, 2013
17
15
-
Houston High School
2011, 2013, 2015
388
397
375
Mat-Su Career & Tech Ed High School
2011, 2013, 2015
422
436
459
Palmer High School
2011, 2013, 2015
774
763
765
Susitna Valley High
2011, 2013, 2015
129
108
119
Wasilla High School
2011, 2013, 2015
Traditional Total
1,242
1,242
1,172
4,176
4,070
3,884
Alternative Schools
American Charter Academy
Burchell High School
Mat-Su Day School
Valley Pathways
2015
152
67
-
2011, 2013, 2015
271
175
285
2011, 2013
40
48
-
2011, 2013, 2015
Alternative Total
All Total
199
157
157
662
447
442
4,838
4,517
4,326
Source: YRBS, DEED.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 103
Limitations
The middle school and alternative, traditional, and all high school YRBS data is available for different years with
different demographic breakouts. The disparate nature of the data hinders comparison and analysis. Middle
school data is only available for Mat-Su and statewide. It includes breakouts by gender and race/ethnicity,
though it is limited to a single year. Data on traditional high schools in Mat-Su is available for three years and
includes demographic breakouts. However, those demographic breakouts are available only for Mat-Su and not
statewide or nationally. There are three years of alternative high school data for Mat-Su and statewide, though
demographic breakouts are only for Mat-Su. Similarly, data on all high schools (alternative and traditional) does
not include national figures. Also, all high school data does not include gender comparisons.
Further limitations arise when estimating the number of students affected by indicators. This estimation is a
function of both prevalence rates and school enrollment. School classifications (e.g. traditional or alternative)
change year to year, which affects enrollment totals for alternative and traditional schools. Consequently, the
estimated number of affected students changes because of variation in not only prevalence but enrollment as
well. Changes in the estimated number of affected students may not reflect changes in the total number of
affected students.
National Survey on Drug Use and Health (NSDUH)
The National Survey on Drug Use and Health (NSDUH) is an annual nationwide survey of randomly selected
individuals 12 years of age and older. The survey provides data on the use of tobacco, alcohol, illicit drugs
(including non-medical use of prescription drugs) and mental health in the United States.
Data provided for this report was collected over a 10-year sample period between 2002-2012. Prevalence rates
represent an average of the entire time period and not each individual year. Reported regions include Mat-Su,
Alaska, and the U.S.
Methodology
Population data by age group was obtained from DOLWD. An average of the population 12 years of age and
older from 2002 through 2011 was calculated. These populations were used with the prevalence data to
calculate the estimated populations in this report.
Limitations
The NSDUH dataset represents an outdated sample that does not capture the current scope of prescription
opioid misuse and heroin use. The data is an average over a ten-year period between 2002 and 2012, which
does not allow for trends over time and does not capture recent years during which the heroin and prescription
drug problem is thought to have rapidly expanded. Also, NSDUH addresses all people 12 years of age and older,
including not only the target population (12-25 years of age), but older adults as well.
Community Needs Assessment
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McDowell Group, Inc.  Page 104
Young Adult Substance Use Survey (YASUS)
In support of the SPF-PFS grant, the Young Adult Substance Use Survey (YASUS) aims to obtain state and regionlevel estimates of opioid and heroin consumption, and consequences among 18-25-year-olds. It also targets
information on the intervening variables of social availability, retail availability, and perceived risk of harm.
The first and only year of available data is 2016. In Mat-Su, 1,313 individuals were invited to participate. From
those invitations, 143 individuals between ages 18-25 responded to the survey.
Methodology
Data are presented as provided by YASUS. The data provided by the State of Alaska and UAA did not include
margins of error or confidence intervals to make statistical comparisons.
Limitations
YASUS began in 2016 and provides just one year of data. In Mat-Su, the 143 individuals that completed YASUS
represent 1.4 percent of the region’s estimated population of 9,679 individuals age 18-25 in 2015. The sample
size for some questions was even smaller than 143. Such small sample sizes limit the ability to consider YASUS
prevalence rates as representative of the entire Mat-Su population.
National Poisoning Data System (NPDS)
The National Poisoning Data System (NPDS) tracks poison exposure outbreaks across the country. Data were
uploaded from American Association of Poison Control Centers that cover all the U.S. data provided for the PFS.
Data track the number and rates of poisonings by sedatives, anti-depressants, stimulants, opioids, and ethanol.
Methodology
Data were collected annually for a four-year time period between FY2012-FY2015. Rates per 10,000 population
were calculated using population estimates from ACS for Mat-Su Borough and Alaska population estimates
from DOLWD.
Table 64. Mat-Su and Alaska Population, Ages 12-25, 2012-2015
2012
Mat-Su
Population*
20,403
Alaska
Population
161,116
2013
20,403
163,752
2014
20,403
162,203
2015
20,403
163,752
Year
*Note: Mat-Su population data from ACS and provided
by NPDS.
Source: ACS and DOLWD.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 105
Health Facilities Data Reporting Program (HFDR)
The Alaska Health Facilities Data Reporting Program (HFDR) collects health care utilization data from inpatient
and outpatient health facilities throughout the state. Historically, health facility participation in the program has
been voluntary, but in 2015 participation became mandatory.
In support of the SPF-PFS grant, HFDR supplied for the entire state and each borough, the 2015 count of ED
discharges for: any heroin-related reason, heroin poisoning, any prescription opioid-related reason, and any
prescription opioid-poisoning. Data were provided by demographic categories of gender, age (12-17, 18-25),
and race (White, Alaska Native, Other). Data do not include associated costs or charges for the ED discharges.
Methodology
Counts of ED discharges were presented in total and by demographic breakout. Within demographic breakouts,
counts were analyzed as a proportion of the total count. These proportions were compared with proportional
population distributions for each demographic group. Population distributions were calculated from DOLWD
2015 population estimates. When target population age groups did not conform to DOLWD’s five-year
groupings, DOLWD grouping totals were separated by averaging each year of age. The table below presents
Mat-Su population estimates for 2015.
Table 65. Mat-Su Borough 2015 Population Estimates, by Age and Gender
Age
Group
0-4
Total
Male
Female
7,478
3,779
3,699
5-9
8,324
4,348
3,976
10-14
7,893
4,072
3,821
15-19
7,078
3,837
3,241
20-24
5,570
2,918
2,652
25-29
6,388
3,249
3,139
30-34
7,267
3,693
3,574
35-39
6,606
3,424
3,182
40-44
6,274
3,243
3,031
45-49
6,372
3,314
3,058
50-54
7,165
3,745
3,420
55-59
7,234
3,766
3,468
60-64
6,245
3,161
3,084
65-69
4,313
2,260
2,053
70-74
2,745
1,403
1,342
75-79
1,536
829
707
80-84
946
458
488
85-89
527
225
302
90+
Total
217
75
142
100,178
51,799
48,379
Source: DOLWD.
See below for a table of the ICD-9 and ICD-10 codes that comprise each discharge category.
Community Needs Assessment
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McDowell Group, Inc.  Page 106
Table 66. ICD-9 and ICD-10 Codes for Prescription Opioid and Heroin-Related
and Poisoning Discharges
Type of ER Discharge
ICD-9 Codes
ICD-10 Codes
The total number of ER
discharges
All ICD-9 codes
All ICD-10 codes
Number of heroinrelated ER discharges
965.01, E850.0,
E935.0
T40.1
Number of Rx opioidrelated ER discharges
E950.0, 305.5, 304.0,
304.7, 304.8, E850.1,
E850.2, 965.02,
965.09
F11, T40.2 (except
T40.2X6), T40.3 (except
T40.3X6)
Number of heroin ER
poisoning discharges
965.01, E850.0
T40.1
Number of Rx opioid
ER poisoning
discharges
E850.1, E850.2,
965.02, 965.09
T40.2X1, T40.2X2,
T40.2X3, T40.2X4,
T40.3X1, T40.3X2,
T40.3X3, T40.3X4
Demographic
Breakouts
•
•
•
Gender
Age (12-17, 18-25)
Race (White, AK
Native, Other
Source: HFDR.
Limitations
The State provided the number of ED discharges due to: any heroin-related reason, heroin poisoning, any
prescription opioid-related reason, and prescription opioid poisonings. These counts were determined by
querying ICD-9 and ICD-10 codes. Problems with this methodology arise because patients often present to the
ED not for drug use but because of the medical problems that result from drug use. Consequently, physician
coding may indicate the medical problem treated but not its relation to drugs. Examples of conditions
commonly related to drugs, especially heroin and prescription opioids, include mental disorders, suicide,
abscess, bacterial infection, hypoglycemia, trauma injuries, acidosis, respiratory arrest, and respiratory
depression, among others. 86,87 One study of the prevalence of adverse drug events (unintended symptoms of
abnormal lab work from either appropriate or inappropriate use of prescription or over the counter drugs) found
coding in the ED captured just 6.8 percent of adverse drug events that actually occurred. 88
CDC WONDER
The Centers for Disease Control and Prevention (CDC) Wide-Ranging OnLine Data for Epidemiological Research
(WONDER) Multiple Cause of Death Database provides access to county-level mortality data throughout the
country. Mortality data comes from death certificates and causes of death are indicated by ICD-10 codes.
In support of the SPF-PFS grant, data from the Multiple Cause of Death Database was provided at the county
(borough) level for deaths involving heroin, deaths involving prescription opioids, and death involving any type
of opioid. Provided by the State were death counts summed over the five-year period between 2009 and 2013.
http://emedicine.medscape.com/article/166464-clinical
Slavova, S., Bunn, T. L., & Talbert, J. (2014). Drug Overdose Surveillance Using Hospital Discharge Data. Public Health Reports, 129(5), 437–
445.
88 Hohl, C. M., Kuramoto, L., Yu, E., Rogula, B., Stausberg, J., & Sobolev, B. (2013). Evaluating adverse drug event reporting in administrative
data from emergency departments: a validation study. BMC Health Services Research, 13, 473. http://doi.org/10.1186/1472-6963-13-473
86
87
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 107
Within each cause of death category, only counties (boroughs) that reported greater than 20 deaths over the
five-year period were included.
Methodology
Counts were presented as provided. Rates per 10,000 population were calculated using the sum of the annual
population in Mat-Su between the years 2009-2013. The table below presents the population estimates used
for the rate calculation.
Table 67. Mat-Su Borough Population Estimates, All Ages, 2009-2013
Year
2009
Population
Estimate
86,074
2010
88,995
2011
91,721
2012
93,685
2013
96,022
5-Year Total
456,497
Source: DOLWD.
Limitations
Cause of death data retrieved from this data source only captures numbers at the county/borough-level with
five-year death counts exceeding 20. It may be possible to query the dataset for information at the state and
national level; however, the criteria used for the initial query of county/borough-level data were never provided
to allow for replication. As such, statewide and national comparisons were not available.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 108
Appendix D: References
Ciccarone, D. (2009). Heroin in brown, black and white: Structural factors and medical consequences in the US
heroin market. International Journal of Drug Policy, 20(3), 277-282.
Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid
use and heroin use. New England Journal of Medicine, 374(2), 154-163.
Daniulaityte, R., Falck, R., & Carlson, R. G. (2014). Sources of pharmaceutical opioids for non-medical use among
young adults. Journal of Psychoactive Drugs, 46(3), 198-207.
Daniulaityte, R., Falck, R., & Carlson, R. G. (2012). “I’m not afraid of those ones just ‘cause they’ve been
prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids. International Journal of Drug
Policy, 23(5), 374-384.
Habal, Rania. "Heroin Toxicity Treatment & Management."Available at:
http://emedicine.medscape.com/article/166464-clinical Accessed on January 23, 2017.
Hoffer, L., & Alam, S. J. (2013, April). “Copping” in Heroin Markets: The Hidden Information Costs of Indirect
Sales and Why They Matter. In International Conference on Social Computing, Behavioral-Cultural Modeling,
and Prediction (pp. 83-92). Springer Berlin Heidelberg.
Ihongbe, T. O., & Masho, S. W. (2016). Prevalence, correlates and patterns of heroin use among young adults in
the United States. Addictive Behaviors, 63, 74-81.
Injury Prevention & Control: Opioid Overdose. Webpage. Available at:
https://www.cdc.gov/drugoverdose/policy/successes.html. Accessed on January 25, 2017.
Lipari, R. & Hughes, M.S. (2015). Trends in heroin use in the united states: 2002 to 2013. Substance Abuse and
Mental
Health
Services
Administration.
Available
at:
https://www.samhsa.gov/data/sites/default/
files/report_1943/ShortReport-1943.html.
Mars, S. G., Fessel, J. N., Bourgois, P., Montero, F., Karandinos, G., & Ciccarone, D. (2015). Heroin-related
overdose: The unexplored influences of markets, marketing and source-types in the United States. Social
Science & Medicine, 140, 44-53.
McCabe, S. E., Schulenberg, J. E., O'Malley, P. M., Patrick, M. E., & Kloska, D. D. (2014). Non‐medical use of
prescription
opioids
during
the
transition
to
adulthood:
a
multi‐cohort
national
longitudinal
study. Addiction, 109(1), 102-110.
Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical
prescription opioid use and abuse and dependence: results from a longitudinal nationally representative
sample. Drug and Alcohol Dependence, 132(1), 107-113.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 109
Keyes, K. M., Cerdá, M., Brady, J. E., Havens, J. R., & Galea, S. (2014). Understanding the rural–urban differences
in nonmedical prescription opioid use and abuse in the United States. American Journal of Public Health, 104(2),
e52-e59.
State of Alaska Department of Health and Social Services. (2016). Prevention of non-medical use of prescription
opioids
and
heroin
use
in
Alaska.
Available
at:
http://www.iser.uaa.alaska.edu/Projects/pfs/docs/
PFSGuidanceDocument.pdf.
SAMHSA. (2016). Preventing prescription drug misuse: understanding who is at risk. Center for Application of
Prevention Technologies.
SAMHSA. (2013). Risk and protective factors associated with nonmedical use of prescription drugs. Center for
Application of Prevention Technologies.
Tetrault, J. M., & Butner, J. L. (2015). Focus: Addiction: Non-Medical Prescription Opioid Use and Prescription
Opioid Use Disorder: A Review. The Yale Journal of Biology and Medicine, 88(3), 227.
Votaw, V. R., Wittenauer, J., Connery, H. S., Weiss, R. D., & McHugh, R. K. (2017). Perceived risk of heroin use
among nonmedical prescription opioid users. Addictive Behaviors, 65, 218-223.
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 110
Appendix E: National Survey of Drug Use and Health Data
This appendix contains all the NSDUH data. The following indicators with asterisks next to them were not included in the body of the report. On a whole, this
data cover a large time period and do not capture recent years. However, indicators were included in the report body where they filled gaps in the information
and no other source was available. In the table below, “CI” refers to “Confidence Interval.”
Table 68. Prescription Drug Indicators, Mat-Su, Alaska, and the U.S.
Mat-Su
%
Mat-Su
CI %
Alaska
%
Alaska
CI %
U.S.
%
U.S.
CI %
Estimated
Number of
Mat-Su
Residents
Statistical
Difference
Between Mat-Su
and Alaska
Statistical
Difference
Between Mat-Su
and U.S.
16.0
12.9-19.8
16.2
15.1-17.4
13.4
13.3-13.6
10,311
Past year use*
4.5
3.7-5.5
5.5
4.9-6.2
4.8
4.7-4.9
2,900
Past month use*
1.7
1.1-2.7
2.3
1.9-2.7
2.0
1.9-2
1,095
Past year pain reliever
dependence
0.6
0.2-1.5
0.5
0.3-0.7
0.5
0.5-0.5
387








Past year pain reliever abuse
0.3
0.1-0.5
0.1
0.1-0.2
0.2
0.2-0.2
193
Ever tried heroin*
3.2
1.9-5.4
2.4
1.8-3.1
1.5
1.5-1.6
2,062
Past year use*
0.4
0.2-0.9
0.2
0.2-0.4
0.2
0.2-0.2
258
Past month use*
0.3
0.1-0.7
0.1
0-0.1
0.1
0.1-0.1
193








Impossible
36.6
30.1-43.6
42.3
40.2-44.5
41.5
41.2-41.7
755
Very difficult
22.3
18.1-27.2
27.5
26-29.1
24.9
24.7-25.1
460
Fairly difficult
21.3
17.6-25.4
17.4
15.9-19
16.4
16.2-16.6
439
Fairly easy
15
9-23.8
9.2
8-10.6
11.1
10.9-11.2
309
Very easy
4.8
3-7.8
3.6
3-4.2
6.2
6.1-6.3
99










Description
Ever used pain relievers nonmedically*
Difficulty in getting heroin
Community Needs Assessment
Appendices
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Appendix F: Community Readiness Respondent
Characteristics
This appendix contains the distrubution of responses to the Community Readiness Survey for prescription drug
misuse and heroin use by sociodemographic factors.
Table 69. Opioid Community Readiness Respondents by Sociodemographic Variables (Total
Respondents = 78)
Sociodemographic Variable
Percent (%)
Gender
Female
78.21
Male
20.51
Age Group
21-40 Years
26.92
41-60 Years
55.13
61-80 Years
17.95
Mat-Su Geographic Region
Big Lake
1.33
Houston
1.33
Knik-Fairview
6.67
Palmer
49.33
Talkeetna
5.33
Wasilla
34.67
Willow
1.33
Respondent Type
Parent
16.88
Business
3.90
Civic/Volunteer
12.99
Healthcare
27.27
Law Enforcement
3.9
Media
1.3
Organizations Working to Reduce Substance Use
Religious
11.69
2.6
Schools
10.39
State, Local, or Tribal Government
Youth Serving
5.19
3.9
Race/Ethnicity
Native Alaskan/American Indian
2.6
White
92.1
Black
1.3
Other
3.9
Source: Mat-Su 2016 Community Readiness Survey Results
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 112
Table 70. Heroin Community Readiness Respondents by Sociodemographic Variables (Total
Respondents = 32)
Sociodemographic Variable
Percent (%)
Gender
Female
84.33
Male
15.63
Age Group
21-40 Years
28.13
41-60 Years
40.63
61-80 Years
31.25
Mat-Su Geographic Region
Palmer
58.06
Talkeetna
9.68
Wasilla
29.03
Willow
3.23
Respondent Type
Parents
34.38
Youth
3.13
Civic/Volunteer Groups
12.50
Healthcare Professionals
18.75
Law Enforcement
3.13
Media
3.13
Organizations Working to Reduce Substance Abuse
6.25
Schools
6.25
State, Local & Tribal Government
6.25
Youth Serving
6.25
Race/Ethnicity
Native Alaskan/American Indian
6.25
White
93.75
Source: Mat-Su 2016 Community Readiness Survey Results
Community Needs Assessment
Appendices
McDowell Group, Inc.  Page 113
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